Low Regional Tibial Bone Density in Athletes with Medial Tibial Stress Syndrome Normalizes after Recovery from Symptoms

Abstract

Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms. Initially localized low bone mineral density is not an inherited condition, but instead may develop in conjunction with the symptoms.

Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test

“…Bone scans, x-ray, Doppler US and compartment pressure tests are used to differentiate MTSS from compartment syndrome, popliteal artery entrapment syndrome and frank stress fracture. The syndrome is thought to include periostitis, bone stress and/or musculotendinous breakdown, although there is conflict in the literature as to which of these elements is most consistently a source of pain, with the weight of literature appearing to favour bone stress reaction 5 6. The adaptive capacity of bone in response to loading through mechanical stimuli has long been understood and described (Wolff's Law) 11 14…”

“…Flexor muscles of the foot, toes and ankle also have some attachment here and likely add to loading of the bone–muscle interface. Measurable reductions in bone density at the site of injury can be present for up to 7 years postonset of symptoms 5. Left untreated the condition can progress to full stress fracture 8 9.…”

Tibial Stress Injuries: Aetiology, Classification, Biomechanics and the Failure of Bone

“…The authors demonstrated that at the injury site, male athletes with chronic MTSS had localised decreased BMD, and this reduction was bilateral even when the injury was unilateral. Additionally, they found that BMD normalises after recovery from the injury (Magnusson et al, 2003). At other sites of the tibia, the MTSS patients had higher BMD than the control group but lower BMD than the athletic control group.…”

“…It is now evident that MTSS involves alterations to at least the cortical bone of the tibia (Johnell et al, 1982;Magnusson et al, 2001;Magnusson et al, 2003;Franklyn et al, 2008;Murrihy, 2009), although whether the trabecular bone is also involved is unknown. This was first evident in the study by Johnell et al (1982), where cortical bone and soft tissue biopsies were obtained from control (non-injured) patients and patients with chronic MTSS.…”

Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study

“…Recent studies showed that with overloaded remodelling the cortex appears osteopaenic on CT scans and that dual energy x-ray absorptiometry scans reveal decreased bone density 10 11. When MTSS symptoms subside the bone density returns to normal values,12 suggesting that MTSS is related to mechanical overloading of the bone.…”