Medial Tibial Stress Syndrom

Transcription

1 Medial Tibial Stress Syndrom Ministry of Health:- Hong Kong January 2007

2 Tibial Fasciitis, Shin Splints Tibial Stress Fracture Definition Overuse, Inflammatory condition Most common cause of lower limb pain in athletes and runners (Clanton & Schon 1993) Site of Pain 1 Posterior Medial border of the Tibia (Medial distal 1/3 tibia) 2 Anterior crest of the Tibia

3 Classification Type 1 Represents a stress fracture Type 2 Chronic periosteal reaction Type 3 Posterior tibial or compartment syndrome

4 Tibialis Posterior Muscle Soleal / Popliteal line Tibialis Posterior Flexor Ditorum Longus Medial Cuneaform Metatarsal Insertion Navicular Insertion Origin Insertion 1 Posterior surface Interosseus Membrane 2 Superior 2/3 med portion posterior aspect fibula 3 Superior surface posterior tibia lateral to vertical line Tuberosity of Navicular / Metatarsal Bones

5 Tibia Lateral Fibula Compartmental / Muscular l Fascia Neale 2006

6 (Shin splints) Aetiology Overuse Injury Starting an exercise programme Biomechanical dysfunction (abnormal pronation) Differential Diagnosis Tibial Stress Fracture Posterior compartment syndrome

7 (Posterior / Anterior Shin Splints) Pathology Periostitis of the tibia Posterior Tibial Muscle overuse Anterior Tibial Muscle overuse Insertional fasciitis of the soleal muscle

8 (Anterior Posterior Shin Splints) Classification Grade 1 Pain upon palpation Medial tibial crest No pain during activity Grade 2 Pain upon palpation Medial tibila crest No Pain during activity Pain post activity

9 (Anterior Posterior Shin Splints) Classification Grade 3 Pain upon palpation Medial tibila crest Pain during activity Pain post activity Grade 2 Pain upon palpation Medial tibila crest No activity without pain even simple walking

10 (Anterior Posterior Shin Splints) Signs and Symptoms Pain:- Appearance Posterior medial border of the tibia Gradual slow onset Exacerbated by activity Relieved by rest Dull ache Severe pain (VAScale) No symptoms in the foot or ankle Mild swelling posterior medial border of tibia

11 (Anterior Posterior Shin Splints) Radiographic appearance -ve in most cases Differential diagnosis Shin splints / Stress Fracture Bone scan Localised periostitis

12 (Anterior Posterior Shin Splints) Acute Phase 1-2 Weeks R.I.C.E. Biomechanical Evaluation of foot function Running shoe evaluation Temporary orthotic provision Muscle strengthening exercises (post comp)

13 (Anterior Posterior Shin Splints) Rehabilitation phase Physical Therapies :- Ultrasound X Ray if a stress fracture is suspected Functional orthosis if abnormally pronated Continued rest Non Steroidal anti- inflammatory medication

14 (Anterior Posterior Shin Splints) Functional Phas Check control of abnormal pronation Footwear evaluation

15 (Stress Fracture) Etiology:- Theory 1 (Stanitski et al 1978) Muscle fatigue Lack of shock absorption Excessive force to underlying bone Theory 2 (Taumpton et al 1981) Secondary to abnormal muscular force / contraction + Sudden increase in training

16 (Stress Fracture) Signs and Symptoms Gradual onset of pain Exacerbated by activity Releived by rest Eventually pain upon walking Examination Localised tenderness over medial aspect of tibia Pain upon Palpation Percussion pain Inflammation

17 (Stress Fracture) Radiographic Evaluation Initial Radiographic evaluation ve 2/3 weeks post symptoms Radiographic evaluation +ve Bone scan if suspicious of stress fracture (Technetium)

18 (Stress Fracture) Treatment Radiographic evaluation

19 (Stress Fracture)

20 (Stress Fracture)

21 (Stress Fracture)