8/3/2023 0 Comments Stress fracture shin mri![]() There are a spectrum of findings ranging from normal, to periosteal and marrow oedema, to stress fracture. MRI: MRI is the most sensitive examination. Stress fractures on bone scan show a focal intense hyperperfusion and hyperaemia in phase 1 and 2, and focal fusiform uptake in phase 3. There are normal findings on the flow phase (phase 1), and blood pool phase (phase 2). Findings are a diffuse longitudinal increased uptake along the posteromedial border of the tibia in the delayed phase (phase 3). Ultrasound: On ultrasound there may be focal hyperechoic elevation of the periosteum with irregularity over the distal tibial and increased flow on Doppler.īone Scan: 3-phase bone scan is fairly sensitive. This is differentiated from stress fracture which shows the "dreaded black line."ĬT: CT is not very sensitive, but may show mild osteopenia as an early sign of fatigue injury of the cortical bone in the tibial diaphysis. Long-term changes may occur with subtle periosteal exostoses around the cortex of the tibia medially. They are insensitive and often normal, especially in the early phase. Plain Radiographs: Plain films are indicated to exclude stress fracture. With the "one-leg hop test" the patient can hop at least 10 times on the affected leg, while the patient with a stress fracture cannot without severe pain. Pain may be reproduced with the provocation test which is pain on resisted plantar flexion. There is often foot pronation and a tight Achilles tendon. This is typically 4cm proximal to the medial malleolus, and extends proximally up to 12cm. On physical examination there is tenderness along the posteromedial border of the tibia. There is an earlier onset of pain with more frequent training in latera stages. This is differentiated from exertional compartment syndrome where the pain increases as running continues. The pain is vague and diffuse that spreads along the middle to distal tibia that decreases with running in the early stage. Females have a 1.5-3.5 times increased risk of progression to stress fracture. There is greater PT excursion, peak hip internal rotation, and decreased flexion. ![]() It is not related to anthropomorphic features. Medial (posteromedial): traction periostitis of tibialis posterior and soleus.Anterior (anterolateral): traction periostitis of tibialis anterior on the tibia and interosseous membrane.It is caused by a traction periostitis due to muscle imbalance, overuse, and improper biomechanical alignment. Over-pronation or increased internal tibial rotation, increased external rotation of the hip, particularly in females.History of previous lower extremity injuries.Training errors (sudden increase in training intensity and duration).Runners without enough shock absorption (running on hard or uneven surfaces, improper running shoes).It is found in 10-15% of running injuries, and 60% of leg pain syndromes. Anterior (anterolateral) tibial stress syndrome.Medial (posteromedial) tibial stress syndrome: the most common.
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