ABSTRACT: Shin pain is a common complaint in runners and other active patients. Making a diagnosis can be difficult because the differential is broad and symptoms may overlap. Palpation is an important part of the physical examination. The primary presenting symptom in medial tibial stress syndrome, or "shin splints," is pain localized to the medial border of the distal third of the tibia. Relative rest eliminates the inciting activity. The most obvious examination finding in tibial stress fractures is localized bony tenderness; triple-phase bone scanning is the gold standard in making a diagnosis. High-risk fractures require aggressive management. The mainstay of diagnosis of chronic exertional compartment syndrome is measurement of resting and postexercise compartment pressures. Treatment may be conservative or surgical. (J Musculoskel Med. 2008;25:138-148)
Shin pain is a common complaint in active patients, particularly those who participate in running sports. When a patient presents with shin pain, the physician should be able to recognize the common presentations to direct the workup, treatment, and rehabilitation appropriately. In addition, the complaint should be evaluated properly to avoid missing a potentially more serious condition.
The main causes of shin pain are medial tibial stress syndrome (MTSS), or "shin splints"; tibial stress fracture; and chronic exertional compartment syndrome (CECS).1 Less common causes include referred pain from the lumbosacral spine, neurovascular pathology, and bone tumors.
Many of the disorders may be designated as overuse injuries.The contributing factors include too much activity, inadequate strength and flexibility, muscle imbalance, inappropriate running surface and terrain, lower extremity malalignment, and use of inappropriate footwear.2,3
Making a diagnosis can be difficult because the differential is broad, symptoms may overlap, and atypical presentations may occur. In this article, we discuss the history taking, physical examination, and clinical features of the main and less common causes of shin pain to provide an efficient evaluation. We also describe approaches to effective treatment.
HISTORY
A thorough history taking is essential. The physician must ascertain the circumstances surrounding the injury, the presence of any specific trauma, and a clear description of the symptoms. Obtaining a detailed training history is useful; attention should be paid to any recent changes in mileage, footwear, intensity, or running surfaces. The focus should be on pain onset, the relationship of pain to activity, associated symptoms, and any alleviating or aggravating factors.1,4
