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Medial Tibial Stress Syndrome

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Seen commonly in basketball, running, and gymnastics. Pathology ... History recurring problem?; MOI. Inspection - Varus foot, other deviations ... – PowerPoint PPT presentation

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Title: Medial Tibial Stress Syndrome


1
Medial Tibial Stress Syndrome
  • Shin Splints

By Bryan Bates
2
Medial Tibial Stress Syndrome
  • Stress/Irritation of the medial tibia
  • Also involves tib posterior, tib anterior, and
    sometimes flexor muscles
  • Caused by overload on the tibia and related
    tissues
  • Related to stress fractures, periostitis, or
    compartment syndromes
  • Accounts for 10-15 of all running injuries, and
    up to 60 of all overuse injuries
  • Seen commonly in basketball, running, and
    gymnastics

3
Pathology
  • Exercise (running, jumping, etc) causes
    microtrauma to the tibia
  • With overuse, osteoblasts cant remodel bone fast
    enough to reverse microtrauma
  • Poor shock absorption, due to several factors,
    exacerbates the problem by causing more trauma to
    the bone

4
Risk Factors
  • Weak muscles
  • Shoes with poor support
  • Running on hard surfaces
  • Foot position
  • Excessive Pronation/Hypermobile arches
  • Hindfoot and Forefoot Varus
  • Anything that inhibits the foots ability to
    absorb shock
  • Previous injury and/or inadequate rehab

5
Risk Factors contd
  • Abrupt increase in frequency, intensity or
    duration of workouts
  • Running up or down steep inclines

6
Signs and Symptoms
  • Diffuse pain along the medial border of the tibia
    most other symptoms are due to pain
  • Possible decrease in dorsiflexion ROM
  • Decrease in lower leg muscle strength
  • Inflammation over bone and muscles
  • Local point tenderness indicates stress fracture

7
Examination
  • History recurring problem? MOI
  • Inspection - Varus foot, other deviations
  • Palpation for pain/inflammation along medial
    tibial border
  • ROM Excessive pronation related to decrease in
    dorsiflexion
  • MMT Low leg muscles, intrinsic foot muscles
  • Navicular Drop test extent of pronation

8
Grading System
  • 1 Pain occurs only after activity
  • 2 Pain occurs before and after activity but
    does not affect performance
  • 3 Pain occurs before, during, and after
    activity and affects performance
  • 4 Pain is so severe that participation is
    impossible

9
Differential Diagnosis
10
Differential Diagnosis Contd
  • Important to differentiate between overuse injury
    like shin splints and blood clot or bone tumor
  • Special Test Homans sign
  • Passive dorsiflexion with knee flexed and
    extended
  • Positive sign pain
  • Indicates deep vein thrombosis (blood clot)

11
Management
  • Rule out stress fracture
  • Rest!
  • Only way to completely stop stress on tibia
  • If rest is impossible biking keeps
    cardiovascular system in shape
  • Ice (massage works well)
  • For pain and inflammation
  • Taping to assist weak muscles
  • NSAIDs
  • Be careful with dosage

12
Management/Rehab
  • Bike workout takes stress off tibia and keeps
    cardiovascular system in shape
  • Watch for getting worse ? stress fracture
  • Arch taping, orthotics, better shoes
  • Strengthen weak muscles to correct harmful muscle
    actions
  • Example Strengthen Tibialis Anterior to cause
    supination/prevent excessive pronation

13
Works Cited
  • Butler, A. Standard of Care Tibial Stress
    Injuries. Brigham Womens Hospital Website.
    2005. Available at http//www.brighamandwomens.o
    rg/RehabilitationServices/Physical20Therapy20Sta
    ndards20of20Care20and20Protocols/Tibial20stre
    ss20injuries.pdf. Accessed February 26th, 2007.
  • Magee, D. Orthopedic Physical Assessment 4th
    edition. Philadelphia Elsevier Sciences 2006.
    pg. 808, 839
  • Prentice, W. Arnheims Principles of Athletic
    Training A Competency-based Approach. New York
    McGraw-Hill Companies Inc. 2006. pg. 586-587.
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