Tibial Stress Fractures/Shin Splints
Diagnosis/Definition
- Inflammation due to repetitive stress of the broad proximal portion of any of the musculotendinous units originating from the tibia.
- Symptoms of overuse injury are precipitated by initiation of training, an increase in training intensity or a change in surface or equipment. The mechanism for overuse injury is overload of forces on the muscle, tendon, or bone, which leads to an inflammatory reaction.
Initial Diagnosis and Management
- History and physical examination.
- Rest of the affected muscle-tendon bone unit
- Use of crutches, bracing or casts as needed
- NSAIDs may be beneficial
- Encourage active range of motion.
- Appropriate restrictions of activity.
Ongoing Management and Objectives
- Rest is individualized depending upon severity
- Immobilization should be utilized if simple weight bearing (walking) is painful.
- Obtain Xrays of both legs if pain occurs with simple weight bearing.
- Obtain bone scan for chronic shin splint pain.
- The duration of rest varies from 1-2 days for mild shin splints to several months for severe stress fractures.
- Ice for 10 to 15 mins with hourly reapplication.
- Elevate leg frequently with compressive wraps.
- Slow and sustained active stretches when no pain is present
Indications for referral to Specialty Care
To Physical Therapy: Routine referral for rehabilitation.
In the rare instance when there is a visible fracture line on plain radiographs – orthopaedic consultation is appropriate.
Referral criteria for Return to Primary Care
Completed specialty care.
If symptoms persists for > 6 months despite above treatment.
