Shin Splints - Diagnosis

Diagnosis

MTSS usually occurs late in a sports season for athletes or after prolonged activity for active individuals. However, onset can occur during the initial rigors of exercise after an individual has been inactive for a long period. A typical clinical presentation of this condition involves pain, palpable tenderness, and possibly swelling. Pain associated with MTSS is usually a recurring dull ache over the distal one-third posteromedial cortex of the tibia. In early diagnosis, individuals may experience pain at the beginning of a workout, which may go away by continued activity and then occur again at the end of the activity. As the syndrome progresses pain may stay throughout the whole training or during low intensity activity and may continue at rest. Range of motion in the ankle and foot should not cause pain.

Vascular and neurological examinations produce normal results in patients with MTSS. Radiographies and three-phase bone scans are recommended to differentiate between MTSS and other causes of chronic leg pain.

Chronic lower leg pain results from various conditions such as medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome. These conditions often have many overlapping symptoms which makes a final diagnosis difficult. Therefore, an algorithmic approach was created to help in the evaluation of patients with complaints of lower leg pain, and assist in finding a diagnosis. Confirmation of the diagnosis is key and involves appropriate diagnostic studies including: radiographs, bone scans, magnetic resonance imaging, magnetic resonance angiography, compartmental pressure measurements, and arteriograms.