Shin splints, anterior

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

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

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

• 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation

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

Essentials of Diagnosis

• 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

General Considerations

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

Demographics

• Affects all ages
• Athletes who increase activity intensity and/or duration along with a lack of appropriate recovery between workouts
• Beginning runners

Signs and Symptoms

• 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

Functional Implications

• Pain with standing or during activity
• Inability of injured lower extremity to bear weight
• Pain with closed chain ankle movements (i.e., driving)

Possible Contributing Causes

• 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

Differential Diagnosis

• 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

Imaging

• X-ray for fracture, often limited view
• Computed tomography (CT) scan for detailed imaging
• Bone scan if stress fracture is suspected
• MRI
• MRA
• Arteriograms

Diagnostic Procedures

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