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Condition/Disorder Synonyms

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  • Anterior tibialis tendonitis

  • Anterior lateral tibial periostitis

  • Anterior lateral tibial stress syndrome

  • Anterior lateral stress fracture

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ICD-9-CM Code1

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  • 844.9 Sprains and strains of unspecified site of knee and leg

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ICD-10-CM Code2

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  • S86.919A Strain of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg, initial encounter

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Preferred Practice Pattern3

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Key Features

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Description

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  • Lower anterior lateral leg pain provoked by activity

  • Pain is localized in the anterior lateral aspects of the tibia

  • Produced by stress or traction that causes microtrauma to the soleus muscle at the origin point of the shinbone

  • Stress-reaction inflammation of the periosteal and musculotendinous fascial junctions

  • Results from repeated activity without proper conditioning or allowing enough recovery time between activities

  • Attributed to muscles of the lower extremities being overloaded or by biomechanical irregularities

  • Recurring dull ache along the anterior lateral aspect of the upper tibia

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination

  • Pain increases with active dorsiflexion and when the anterior tibialis muscle is stretched into plantarflexion

  • Muscle length and strength imbalances, especially a tight gastrocnemius-soleus muscle group

  • Common to see compartment syndrome associated with shin splints

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General Considerations

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  • Pain with repetitive activity, when the involved musculotendinous unit is stretched

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Demographics

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  • Affects all ages

  • Athletes who increase activity intensity and/or duration along with a lack of appropriate recovery between workouts

  • Beginning runners

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Clinical Findings

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Signs and Symptoms

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  • Pain: mild to severe

  • Pain with weight-bearing activities and gait

  • Tightness in gastrocnemius, soleus, and plantar muscles

  • Described as a dull ache to lower extremities

  • Point tenderness to tibia at anterior lateral aspect

  • Possible swelling

  • Muscle guarding with passive movement

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Functional Implications

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  • Pain with standing or during activity

  • Inability of injured lower extremity to bear weight

  • Pain with closed chain ankle movements (i.e., driving)

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Possible Contributing Causes

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  • Impaired standing balance

  • Running on too hard of a surface

  • History of high/repetitive impact activities

  • Trauma

  • Improper footwear

  • Chronic ankle injuries

  • Overtraining

  • Muscle imbalance with ankle dorsiflexors and plantarflexors

    • Tight or strong ankle plantarflexors overpowering the dorsiflexors

  • Supinators with decreased shock absorption

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Differential Diagnosis

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  • Vascular disease

  • Compartment syndrome

  • Popliteal artery entrapment syndromes

  • Entrapment of superficial peroneal nerve

  • Spinal stenosis

  • Fascial hernias

  • Tenosynovitis

  • Cellulitis

  • Deep vein thrombosis

  • Infective or varicose periostitis

  • Tumor

  • Fibular dislocation

  • Ankle sprain

  • Achilles tendonitis

  • Lateral collateral ligament sprain

  • Lateral meniscus tear

  • Peripheral vascular injuries

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Means of Confirmation or Diagnosis

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