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  • Writer's pictureLuke Nelson

Diagnosing medial tibial stress syndrome

🦵Suspecting medial tibial stress syndrome? 🏃‍♂️

Medial tibial stress syndrome (MTSS) is a common running injury, making up 16% of all running injuries (Mulvad 2018). A 2017 study suggests that MTSS can be diagnosed with almost perfect reliability with the following tests:

1️⃣ Pain on the medial 2/3 tibia present on exercise & reduced with rest 🩹

2️⃣ Palpable pain of >5cm 📏

3️⃣ No cramping, burning signs over the posterior compartment or neuro signs in the foot (which may suggest exertional compartment syndrome) ❌🔥🦶

4️⃣ Absence of severe swelling or erythema (redness of the skin) 🚫🔴.

Some other key points from this study:

🔑 Concurrent (co-existing) injuries were found in 32% of those assessed, so there can be other things happening at the same time (i.e. compartment syndrome, stress fractures) 🔄🤔

🔑 Imaging can be used to rule out other entities, i.e., stress fractures or tumours, but is rarely required 📸🚫

🔑 The authors of this study chose >5cm area of pain to differentiate between stress fractures & MTSS. For those with tender areas <5cm, a stress fracture may be considered 📊👣.

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📚 References

  • Mulvad, B., et al. (2018). “Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial.” PLoS One 13(10): e0204742.

  • Winters, M., et al. (2017). “Medial tibial stress syndrome can be diagnosed reliably using history and physical examination.” British Journal of Sports Medicine.


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