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  • Anterior tibialis tendonitis
  • Anterior lateral tibial periostitis
  • Anterior lateral tibial stress syndrome
  • Anterior lateral stress fracture

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

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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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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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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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Imaging

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Diagnostic Procedures

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  • Compartmental pressure measurements
  • Palpation of pulses in the foot
  • Capillary ...

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