Radiology Resident Case of the Week
Etiology/Pathophysiology
Periostitis (Shin splints) occur from abnormal demands of the posterior tibialis and soleus muscle on the posteromedial border of the tibia, causing inflammation of the periosteum at the origin of SharpeyÕs fibers. Predisposing factors for shin splints include pronation of the feet, increased subtalar motion; and, possibly improper training, equipment, or playing surfaces.
Pathology:
Miscellaneous
Imaging
Plain film examination is most often normal (image). Three-phase bone scintigrams (bone scan) are useful in diagnosis. Radionuclide angiograms and blood-pool images are normal. Delayed images reveal diffuse periosteal uptake along the posteromedial border of the tibia (image).
DDX
The diagnosis of periostitis is important to the professional or serious amateur athlete because training can be continued when Òshin splintsÓ is present. Periostitis must be differentiated from stress fractures. Stress fractures usually involve more focal pain, radiographic changes, and a characteristic focal area of radionuclide uptake in the affected area. Stress fractures require patients to refrain from activity and often require a short-leg cast. Infection and acute muscle inflammation should also be considered in the differential diagnosis.
Key references
Holder LE, Michael R. The specific scintigraphic pattern of Òshin splints in the lower legÓ: concise communication. J Nucl Med 1984; 25: 865-869.
Henkin R, et al. Nuclear Medicine.
ACR Code
Keywords:
periostitis, shin splints