Shin Pain (Shin Splints)

Medial tibial stress syndrome

• diffuse pain and tenderness across posterior medial aspect of tibia
• dull aching to intense pain alleviated by rest
• initially with pain at beginning of workout but resolves during activity; in later stages pain is often sharper and occurs throughout workout
• need to assess variables that led to injury (e.g., pronation, running shoes, etc.)

Tibial stress fracture

• single area of point tenderness
• posterior-medial or anterior tibia; latter should be referred
• repeated impact activity intensifies the pain
• bone density is an important contributing factor (need at least 1500 mg/day of calcium), biomechanical issues.

Exertional compartment syndrome

• exercise induced pain & swelling, relieved by rest; pain ceases when activity stops; normal exam
• elevated intracompartmental pressure may cause ischemia of muscles

CHLA Board Review 2005