Medial Tibial Stress Syndrome (Shin Splints) - MSK Radiology Imaging Findings: • Within the mid diaphysis of the tibia there is posterior periosteal new bone formation and sclerosis that is more prominent on the 2-month follow-up radiograph. • MRI evidence of periosteal increased signal consistent with edema. • The cortex is thickened with endosteal increased signal and bone marrow edema. Tl -hypointense marrow signal also seen. • Intracortical increased signal is seen posteriorly. This would be a grade IV stress injury (Fredericson) Fredericson MRI classification of tibial stress injuries (estimated time for athlete return) • Grade I: periosteal edema with no marrow signal abnormalities. (3-weeks) • Grade II: periosteal edema with bone marrow edema on T2-sequences. (3-6 weeks) • Grade III: periosteal edema with marrow edema on both T1/T2-sequences. (12-16 weeks) • Grade IV: intracortical signal abnormality with marrow edema on T1/T2-sequences +/- fracture line. (16+ weeks) Bone scan: can see linear longitudinal focally increased uptake on 3-phases. Differential diagnosis: • Osteoid Osteoma: Nidus (intracortical lucency) with surrounding cortical thickening and edema. • Osteomyelitis: Cortical thickening, swelling, marrow edema. HISTORY and EXAM is different. Dr. Donald von Borstel @DrvonBorstel #Shin #Splints #Tibial #Stress #Syndrome #Radiology #diagnosis #msk #clinical
