Medial tibial stress syndrome

1. What is the pathophysiology behind shin splints?
2. What is the main predisposing factor to shin splints?
3. What is the presentation of shin splints?
4. What imaging is done for shin splints?
5. What is the treatment?

Answers:
1. Chronic traction on the periosteum at the periosteal-fascial junction, with possible detachment of periosteum from the bone. Avulsion may occur at the attachment of the soleus to the medial tibia.
2. Hyperpronation.
3. Gradual onset of pain at the posteromedial border of the tibia, which may decrease with exercise and increase after the exercise is completed. History may include excessive use of foot flexors or repetitive running on hard surfaces, recent footwear change. Exam shows tenderness on palpation along medial border of tibia.
4. Bone scan may show uptake along medial tibial border. MRI will r/o stress fx.
5. Rest with avoidance of inciting activity, icing, stretching, return to activity on soft level surfaces when pain free for several days. Orthotics for overpronation. Fasciotomy of posteromedial fascia.