Shin splints, or stress-related anterior lower leg pain, seem to arise from numerous causes, including stress fractures. We retrospectively reviewed 154 consecutive military patients who had magnetic resonance imaging during a 5-year period for stress-related anterior lower leg pain. Using magnetic resonance imaging, 143 bone stress injuries were diagnosed in 86 of the 154 (56%) patients. The incidence of bone stress injury requiring orthopaedic consultation and magnetic resonance imaging among recruits during the 5 years was 117 per 100,000 person years in military service. The bone stress injury was located in the tibia in 141 (99%) patients. Of these injuries, 80 (57%) were located in the distal (1/3) of the tibial shaft, 42 (30%) in the middle (1/3), 14 (10%) in the proximal (1/3), and five (3%) in the medial condyle. The locations of tibial stress injuries related to the magnetic resonance imaging grades. Almost all lower leg fatigue bone stress injuries were located in the tibia, and the distal lateral shaft was affected most often. When used early after onset of symptoms, magnetic resonance imaging provides accurate diagnosis to ensure appropriate treatment, especially when dealing with exercise-induced lower leg pain in physically active patients.
Level of evidence: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence.