The first description of medial tibial stress syndrome (MTSS) was in 1958. Devas
1
published the first study and described signs and symptoms of what he termed stress fracture at the tibia or shin soreness. Other terms like medial tibial syndrome,2
tibial stress syndrome,
3
shin splint syndrome,
4
and medial tibial stress syndrome5
have followed. Numerous definitions for this condition have been described by experienced
sports clinicians, highlighting the vague understanding of this condition. Yates and
White
6
most accurately described MTSS as “pain along the posteromedial border of the tibia
that occurs during exercise, excluding pain from ischemic origin or signs of stress
fracture.” The purpose of this review is to summarize the known data about MTSS and
to give a formal definition and treatment algorithm, allowing for timely diagnosis
and treatment.Keywords
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References
- Stress fractures of the tibia in athletes or shin soreness.J Bone Joint Surg Br. 1958; 40-B: 227-239
- Tibial stress syndrome in athletes.J Sports Med. 1974; 2: 81-85
- The medial tibial syndrome: exercise ischaemia in the medial fascial compartment of the leg.J Bone Joint Surg Br. 1974; 56-B: 712-715
- The shin splint syndrome.Am J Surg. 1967; 114: 875-881
- The medial tibial stress syndrome.Am J Sports Med. 1982; 10: 201-205
- The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.Am J Sports Med. 2004; 32: 772-780
- The soleus syndrome.Am J Sports Med. 1985; 13: 87-94
- Anatomic dissection of the tibialis posterior muscle and its correlation to medial tibial stress syndrome.J Foot Surg. 1990; 29: 105-108
- Medial tibial stress syndrome.J Bone Joint Surg Am. 1994; 76: 1057-1061
- Evaluation of claw toe deformity, weakness of the foot intrinsics, and posteromedial shin pain.Am J Sports Med. 1989; 17: 821-827
- Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction.J Am Podiatr Med Assoc. 2007; 97: 31-36
- Functional adaptation of bone to increased stress.J Bone Joint Surg Am. 1979; 61: 539-546
- Tibial stress injuries.Sports Med. 1998; 26: 265-279
- Strain gradients correlate with sites of periosteal bone formation.J Bone Miner Res. 1997; 12: 982-988
- Strain gradients correlate with sites of exercise-induced bone-forming surfaces in the adult skeleton.J Bone Miner Res. 1997; 12: 1737-1745
- The area moment of inertia of the tibia: a risk factor for stress fractures.J Biomech. 1989; 22: 1243-1248
- From Wolff's law to the Utah paradigm: insights about bone physiology and its clinical applications.Anat Rec. 2001; 262: 398-419
- A 2003 update of bone physiology and Wolff's Law for clinicians.Angle Orthod. 2004; 74: 3-15
- Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes.Am J Sports Med. 2008; 36: 1179-1189
- The effect of muscle fatigue on in vivo tibial strains.J Biomech. 2007; 40: 845-850
- Musculo-skeletal shock absorption: relative contribution of bone and soft tissues at various frequencies.J Biomech. 1978; 11: 237-239
- Morphological bone changes in shin splints.Clin Orthop Relat Res. 1982; : 180-184
- Correlation of bone scintigraphy and histological findings in medial tibial syndrome.Br J Sports Med. 2000; 34: 49-53
- Abnormally decreased regional bone density in athletes with medial tibial stress syndrome.Am J Sports Med. 2001; 29: 712-715
- Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms.Am J Sports Med. 2003; 31: 596-600
- Development and validation of a novel rating system for scoring standing foot posture: The Foot Posture Index.Clin Biomech (Bristol, Avon). 2006; 21: 89-98
- The Foot Posture Index: Rasch analysis of a novel, foot-specific outcome measure.Arch Phys Med Rehabil. 2007; 88: 88-93
- Selected measures of angular displacement, strength, and flexibility in subjects with and without shin splints.Res Q Exerc Sport. 1980; 51: 478-485
- Some biomechanical aspects of the foot and ankle in athletes with and without shin splints.Am J Sports Med. 1983; 11: 125-130
- Factors contributing to the development of medial tibial stress syndrome in high school runners.J Orthop Sports Phys Ther. 2001; 31: 504-510
- Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors.J Orthop Sports Phys Ther. 2007; 37: 40-47
- Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome.J Foot Ankle Surg. 2008; 47: 89-95
- Contributing factors to medial tibial stress syndrome: a prospective investigation.Med Sci Sports Exerc. 2009; 41: 490-496
- Effect of foot posture on the incidence of medial tibial stress syndrome.Med Sci Sports Exerc. 1995; 27: 800-804
- Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.J Am Podiatr Med Assoc. 2008; 98: 436-444
- Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study.Br J Sports Med. 2004; 38: 441-445
- Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: a case-control study.J Sci Med Sport. 2007; 10: 356-362
- A retrospective case-control analysis of 2002 running injuries.Br J Sports Med. 2002; 36: 95-101
- A practical approach for the differential diagnosis of chronic leg pain in the athlete.Am J Sports Med. 2005; 33: 1241-1249
- Medial tibial stress syndrome.Med Sci Sports Exerc. 2000; 32: S27-S33
- Medial tibial stress syndrome: a critical review.Sports Med. 2009; 39: 523-546
- Intracompartmental pressure increase on exertion in patients with chronic compartment syndrome in the leg.J Bone Joint Surg Am. 1981; 63: 1304-1309
- Intramuscular pressures in exercise-induced lower leg pain.Int J Sports Med. 1984; 5: 31-35
- Interstitial pressure measurements in the anterior and posterior compartments in athletes with shin splints.Am J Sports Med. 1977; 5: 127-131
- Stress fractures in athletes.Am J Sports Med. 1987; 15: 46-58
- Medial tibial pain.Clin Orthop Relat Res. 1986; : 167-171
- Bone stress injuries of the lower extremity: a review.Acta Orthop Scand. 2002; 73: 3568-3569
- Imaging of lower extremity stress fracture injuries.Sports Med. 2008; 38: 345-356
- CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities.Radiology. 2005; 235: 553-561
- The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication.J Nucl Med. 1984; 25: 865-869
- Magnetic resonance imaging in stress fractures and shin splints.Clin Orthop Relat Res. 2004; : 260-267
- Shin splints: MR appearance in a preliminary study.Radiology. 1997; 204: 177-180
- A prospective controlled study of diagnostic imaging for acute shin splints.Med Sci Sports Exerc. 1998; 30: 1564-1571
- Clinical significance of nonfocal scintigraphic findings in suspected tibial stress fractures.Clin Orthop Relat Res. 1987; : 200-205
- Tibial periosteal reactions in soldiers.Acta Orthop Scand. 1991; 62: 531-534
- Interpretation and classification of bone scintigraphic findings in stress fractures.J Nucl Med. 1987; 28: 452-457
- Basic principles of nuclear medicine techniques for detection and evaluation of trauma and sports medicine injuries.Semin Nucl Med. 1988; 18: 90-112
- Tibial stress reaction in runners.Am J Sports Med. 1995; 23: 472-478
- The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes.Clin Sports Med. 1997; 16: 291-306
- Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners.AJR Am J Roentgenol. 2004; 183: 635-638
- High-resolution CT grading of tibial stress reactions in distance runners.AJR Am J Roentgenol. 2006; 187: 7893-7899
- A prospective study on the management of shin splints.J Bone Joint Surg Am. 1974; 56: 1697-1700
- [Low-energy laser therapy in medial tibial stress syndrome].Ugeskr Laeger. 1994; 156: 7329-7331
- Use of foot orthoses and calf stretching for individuals with medial tibial stress syndrome.Foot Ankle Spec. 2010; 3: 15-20
- The additional value of a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study.J R Army Med Corps. 2010; 156: 236-240
- Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome.Am J Sports Med. 2010; 38: 125-132
- Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study.Br J Sports Med. 2011; ([Epub ahead of print])
- Case report: comprehensive management of medial tibial stress syndrome.J Chiropr Med. 2002; 1: 122-124
- Results of fasciotomy in patients with medial tibial syndrome or chronic anterior-compartment syndrome.J Bone Joint Surg Am. 1983; 65: 1252-1255
- Surgical treatment of medial tibial stress syndrome (shin splint) by fasciotomy of the superficial posterior compartment of the leg.Scand J Med Sci Sports. 1995; 5: 40-43
- Results of the surgical treatment of the medial tibial syndrome in athletes.Int J Sports Med. 1989; 10: 55-57
- Chronic shin splints.Sports Med. 1986; 3: 436-446
- Outcome of surgical treatment of medial tibial stress syndrome.J Bone Joint Surg Am. 2003; 85-A: 1974-1980
- Prevention of common overuse injuries by the use of shock absorbing insoles.Am J Sports Med. 1990; 18: 636-641
- Does calcium supplementation prevent bone stress injuries?.Int J Sport Nutr. 1992; 2: 165-174
- Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities?.J Manipulative Physiol Ther. 2002; 25: 326-331
- A randomized trial of preexercise stretching for prevention of lower-limb injury.Med Sci Sports Exerc. 2000; 32: 271-277
- Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load: a randomized controlled trial of 1020 army recruits.Am J Sports Med. 2008; 36: 663-670
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