The Medial Tibial Stress Syndrome

Mubarak, Scott J.; Gould, Robert N.; Lee, Yu Fon; Schmidt, D. A.; Hargens, Alan R.

doi:10.1177/036354658201000402

Cited by 188 publications

(75 citation statements)

References 8 publications

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“…In particular, the bone scan was used to detect stress fractures of the rib in rowers, and MR images provided a rapid, anatomically precise diagnosis of stress fractures of the ulnar olecranon in baseball pitchers without additional radiation exposure. The uptake of technetium 99m, particularly in the tibial diaphysis, has had various interpretations; localized focal uptake of technetium 99m suggests a stress fracture (Figure 1), whereas its linear uptake along the periosteum suggests periostitis or stress syndrome (shin splints) [13][14][15] . Therefore, the tibiae showing localized focal uptake but not linear uptake of technetium 99m were diagnosed as having a stress fracture.…”

Section: Methodsmentioning

confidence: 99%

Analysis of stress fractures in athletes based on our clinical experience

Iwamoto

Satō

Takeda³

et al. 2011

WJO

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AIM:To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS:We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS:During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION:The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

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Section: Methodsmentioning

confidence: 99%

Analysis of stress fractures in athletes based on our clinical experience

Iwamoto

Satō

Takeda³

et al. 2011

WJO

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“…33,34,39 Medial tibial stress syndrome (MTSS) is an exercise-induced, localized pain along the distal two thirds of the posterior-medial tibia and can be a debilitating injury in runners. 11,18,27,28,43 In studies of recreational runners, MTSS has been reported as the most 41 or second most frequently diagnosed injury. 8 Clement et al 8 reported that the incidence of MTSS was higher among female runners (16.8%) than male runners (10.7%).…”

mentioning

confidence: 99%

Medial Tibial Stress Syndrome in High School Cross-Country Runners: Incidence and Risk Factors

Plisky

Rauh²,

Heiderscheit³

et al. 2007

J Orthop Sports Phys Ther

122

128

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“…Mubarak et al 16 found histological signs of periostitis and vasculitis in fascial samples from two cases of MTSS and regarded this condition as a separate entity from CECS. Johnell et al 35 examined bone and soft tissue samples (consisting of fascia and periosteum) in patients surgically treated for medial tibial pain, the diagnosis of which was broad and did not distinguish between CECS and MTSS.…”

Section: Inflammatory Findingsmentioning

confidence: 99%

“…14 There has been variability in the terminology used to describe CECS and other causes of exercise induced lower leg pain such as medial tibial syndrome, 15 medial tibial periostitis, 16 and medial tibial stress syndrome, 16 17 the pathology of which may all merge with CECS. For the purpose of this paper, the clinical entity characterised by exercise induced, inflammatory medial tibial pain with palpatory tenderness of the posteromedial tibial border and often accompanied by patchy linear bony uptake on bone scintigraphy will be referred to as medial tibial stress syndrome (MTSS).…”

mentioning

confidence: 99%

Histology of the fascial-periosteal interface in lower limb chronic deep posterior compartment syndrome

2002

Journal of Science and Medicine in Sport

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Objective: To describe the histological features of the fascial-periosteal interface at the medial tibial border of patients surgically treated for chronic deep posterior compartment syndrome and to make statistical comparisons with control tissue. Methods: Nineteen subjects and 11 controls were recruited. Subject tissue was obtained at operation, and control tissue from autopsy cases. Tissue samples underwent histological preparation and then examination by an independent pathologist. Samples were analysed with regard to six histological variables: fibroblastic activity, chronic inflammatory cells, vascularity, collagen regularity, mononuclear cells, and ground substance. Collagen regularity was measured with respect to collagen density, fibre arrangement, orientation, and spacing. The observed changes were graded from 1 to 4 in terms of abnormality. Mann-Whitney U test, Spearman correlation coefficients, and intraobserver reliability scores were used. Results: With regard to collagen arrangement, control tissue showed greater degrees of irregularity than subject tissue (p = 0.01). Subjects with a symptom duration of greater than 12 months (as opposed to less than 12 months) showed greater degrees of collagen irregularity (p = 0.043). Vascular changes approached significance (p = 0.077). With regard to the amount of fibrocyte activity, chronic inflammatory cell activity, mononuclear cells, or ground substance, there were no significant differences between controls and subjects. Good correlation was seen in scores measuring chronic inflammatory cell activity and mononuclear cells (r = 0.649), and moderate correlation was seen between fibrocyte activity and vascular changes (r = 0.574). Intraobserver reliability scores were good for chronic inflammatory cell activity and moderate for vascular changes, but were poor for collagen and fibrocyte variables. Individual cases showed varying degrees of fibrocyte activity, chronic inflammatory cellular infiltration, vascular abnormalities, and collagen fibre disruption. Conclusions: Statistical analysis showed no histological differences at the fascial-periosteal interface in cases of chronic deep posterior compartment syndrome, except for collagen, which showed less irregularity in subject samples. The latter may indicate a remodelling process, and this is supported by greater collagen irregularity in subjects with longer duration of symptoms.

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The Medial Tibial Stress Syndrome

Cited by 188 publications

References 8 publications

Analysis of stress fractures in athletes based on our clinical experience

Analysis of stress fractures in athletes based on our clinical experience

Medial Tibial Stress Syndrome in High School Cross-Country Runners: Incidence and Risk Factors

Histology of the fascial-periosteal interface in lower limb chronic deep posterior compartment syndrome

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