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200: TIBIALIS ANTERIOR TENDINITIS

Dennis Hunt, EdD, CSCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Anterior lateral tibial periostitis

  • Anterior lateral tibial stress syndrome

  • Anterior lateral stress fracture

  • Anterior shin splints

  • Anterior tibialis tendonitis

ICD-9-CM CODE1

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

ICD-10-CM CODE2

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

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

A 23-year-old man presents with bilateral anterior shin pain. He indicates that 3 weeks earlier he began an exercise program that involves jogging 3 miles per day. The patient also indicates that his new exercise program increased his activity level considerably from the past year, with a lot more jogging. The patient has been wearing a pair of old sneakers while jogging. The pain starts about mile 2 and he has to stop running. The X-ray was negative for a stress fracture.

KEY FEATURES

Description

  • 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

FIGURE 200-1

Tibialis anterior (L4, 5; deep peroneal nerve). The foot is dorsiflexed and inverted against resistance applied by gripping the foot with the examiner’s hand. (From Waxman SG. Clinical Neuroanatomy. 26th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Diagnosis usually made by clinical examination

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

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

  • Common to see compartment syndrome associated with shin splints

General Considerations

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

Demographics

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

  • Beginning runners with poor lower-extremity muscle control

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Tightness in gastrocnemius, soleus, and plantar muscles

  • Pain: Mild to severe with weight-bearing activities and gait

  • Described as a dull ache to lower extremities

  • Point tenderness to tibia at anterior lateral ...

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