Tibial periosteal reactions in soldiers: A scintigraphic study of 29 cases of lower leg pain

Nielsen, Michael Bachmann; Hansen, K; Hølmer, Per; Dyrbye, Martin

doi:10.3109/17453679108994489

Cited by 31 publications

(16 citation statements)

References 3 publications

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“…Therefore, patients with shin splints or tibial stress fractures require different treatment methods and periods. Nielsen et al 16 think the term stress fracture should be used only for patients who have an intensive abnormal finding on bone scintigraphs and callus formation as seen on radiographs taken at followup. Plain radiographs in patients with stress fractures show periosteal new bone formation in the late phase.…”

Section: Discussionmentioning

confidence: 98%

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Magnetic Resonance Imaging in Stress Fractures and Shin Splints

Aoki¹,

Yasuda²,

Tohyama³

et al. 2004

Clinical Orthopaedics &Amp; Related Research

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The purpose of the current study was to determine whether stress fractures and shin splints could be discriminated with MRI in the early phase. Twenty-two athletes, who had pain in the middle or distal part of their leg during or after sports activity, were evaluated with radiographs and MRI scans. Stress fractures were diagnosed when consecutive radiographs showed local periosteal reaction or a fracture line, and shin splints were diagnosed in all the other cases. In all eight patients with stress fractures, an abnormally wide high signal in the localized bone marrow was the most detectable in the coronal fat-suppressed MRI scan. In 11 patients with shin splints, the coronal fat-suppressed MRI scans showed a linear abnormally high signal along the medial posterior surface of the tibia, and in seven patients with shin splints, the MRI scans showed a linear abnormally high signal along the medial bone marrow. No MRI scans of shin splints showed an abnormally wide high signal in the bone marrow as observed on MRI scans of stress fractures. This study showed that fat-suppressed MRI is useful for discrimination between stress fracture and shin splints before radiographs show a detectable periosteal reaction in the tibia.Athletes frequently experience chronic pain induced by exercise in the medial aspect of the lower leg. Because the pain disturbs their sports activities, it is necessary for a patient with chronic leg pain to be diagnosed correctly as early as possible. Stress fractures and shin splints are wellknown as causes of chronic leg pain. Although shin splints and tibial stress fracture are involved in overuse injuries, they are different diseases. 14,15,19 According to the standard nomenclature of the American Medical Association as reported by Slocum, 19 shin splints are defined as pain and discomfort in the leg from repetitive running on hard surfaces or excessive use of foot flexors. The diagnosis should be limited to musculotendinous inflammation excluding fractures and ischemic disorders. However, stress fractures are recognized as the continuum of changes from microfracture to frank fracture under excess stress. However, patients with stress fractures or shin splints have similar symptoms and they have similar clinical signs, at least during the early phase of each disease. Because treatment of these diseases is different, early discrimination between shin splints and stress fractures is important for athletes. Athletes with shin splints do not need a long rest time, but all athletes with stress fractures of the tibia should cease sports activity for at least 4 or 6 weeks. Early discrimination between shin splints and stress fractures can allow athletes a return to sports activity as early as possible.The differential diagnosis between these two diseases is difficult in the early phase as determined from the physical examination and the radiographs. Radiographs are not useful in the early phase of stress fractures, although they are useful in the late phase because they show periosteal reaction, callus...

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Section: Discussionmentioning

confidence: 98%

“…12 Some authors reported that 20-40% of the lesions seen on scintigraphs were asymptomatic. 16,25 It is difficult to differentiate shin splints from stress fractures in the early phase with a bone scan. 14 Examination with a bone scan is more invasive than MRI.…”

Section: Diagnosis Mri Scansmentioning

confidence: 99%

Magnetic Resonance Imaging in Stress Fractures and Shin Splints

Aoki¹,

Yasuda²,

Tohyama³

et al. 2004

Clinical Orthopaedics &Amp; Related Research

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“…In the diagnosis of a stress‐related injury to bone, radiography has been used as the primary imaging tool. In the early stages of these injuries, the sensitivity of radiography may be as low as 10%, and 30–70% at follow‐up (5, 12, 15, 17, 18). So far, the diagnosis has often been based on bone scintigraphy, which is regarded as the gold standard (1).…”

mentioning

confidence: 99%

MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity

Kiuru

Pihlajamäki

Hietanen³

et al. 2002

Acta Radiologica

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“…Conventional radiography has been the primary examination modality used in the assessment of a stress‐related bone injury. Unfortunately, the sensitivity of plain film radiography is poor (6, 8), and it has often been necessary to confirm the diagnosis with scintigraphy which has been used as the gold standard. Recently, the diagnostic usefulness of MR imaging has been verified.…”

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confidence: 99%