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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.