Letters

Trauma related shin splints

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7197.1560 (Published 05 June 1999) Cite this as: BMJ 1999;318:1560

Shin splints are symptoms, not a diagnosis

  1. Robert Ashford, Orthopaedic registrar. (rashford{at}arafura.demon.co.uk)
  1. Sandwell District General Hospital, West Bromwich B71 4HJ
  2. Department of Nuclear Medicine, Royal Hospital Haslar, Gosport, Hampshire PO12 2AA

    EDITOR—Macleod et al's comment that bone scans were abnormal if stress fractures or shin splints were present1 is inaccurate. Shin splints are a clinical feature (posteromedial tibial pain and tenderness) rather than a diagnosis.

    Isotope bone scanning forms part of the investigation of tibial pain. The three commonest causes of such pain are stress fracture; periostitis near the origin of the flexor digitorum longus or soleus, or both; and chronic exertional compartment syndrome. These give rise to different findings on isotope bone scanning: localised increased uptake (stress fracture), linear streaking over the posteromedial tibia (periostitis), and essentially normal findings (chronic exertional compartment syndrome).

    Clinical assessment is essential for differentiating between these three conditions, and isotope bone scanning undoubtedly plays a part in this assessment. Taking the findings of such scanning in isolation, however, is flawed.

    References

    Author's reply

    1. M A Macleod, Consultant in nuclear medicine. (murdo{at}haslar.demon.co.uk)
    1. Sandwell District General Hospital, West Bromwich B71 4HJ
    2. Department of Nuclear Medicine, Royal Hospital Haslar, Gosport, Hampshire PO12 2AA

      EDITOR—In common with most imaging specialists, we tend to use Holder and Michael's findings to define shin splints. They found localised abnormal uptake in the middle and distal thirds of the posteromedial aspect of the tibial cortex in nine of 10 patients being investigated for shin splints.1 This appearance in bone scintigrams has been confirmed by others24 and has led to the term shin splints being used as a synonym for and definitive indication of periostitis, with bone involvement being a precursor of stress fractures.

      Ashford may well be right in a narrow sense, but the term shin splints is now used, along with a plethora of synonyms, signs, and symptoms,5 to describe intermittent pain in the lower extremities associated with a specific scintigraphic appearance.

      References

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