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

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