Learning Radiology xray montage

"Shin Splints"

General Considerations

  • Catch-all term used to describe almost any pain in tibia
  • The most common cause of shin splints is medial tibial stress syndrome
    • Seen in military personnel and amongst athletes
  • Exercise induced pain and tenderness along posterior-medial border of tibia
  • Usually seen in athletes who increase their training

Clinical Findings

  • Dull, aching pain on posterior and medial aspect of calf
  • Frequently occurs at beginning of a sports season

Imaging Findings

  • Conventional radiographs are normal
  • Nuclear medicine bone scans
    • Blood pool images are normal
    • Long, longitudinally-oriented uptake on delayed images in posterior tibia
      • Tracer uptake varied along length of lesion
    • Must obtain both lateral and medial views
    • Findings differentiate shin splints from stress fractures

Differential Diagnosis

  • Stress fracture
  • Chronic compartment syndrome
  • DVT
  • Muscle strain


  • Rest
  • Ice
  • Compression
  • Elevation

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"Shin Splints." White arrows point to linear region of increased uptake in tibia on delayed radionuclide"Triple phase" bone scan images consistent with so-called shin splints in this young athlete. The blood flow study shows equal flow in both calves (red circle) .
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The Specific Scintigraphic Pattern of  Shin Splints in the Lower Leg: Concise Communication.  Lawrence E. Holderand and Roger H. Michael. J Nuci Med 25: 865-869, 1984