Clinical features of medial tibial stress syndrome

Menendez, 2020Winters, 2018

In a tibial stress reaction and stress fracture, pain along the bone border may be related to heel strike. In a stress reaction, pain typically occurs at the onset of activity and disappears with cessation of activity. Sometimes there is a pattern of pain easing as the athlete warms up, only to reappear briefly after cessation of exercise.

In a stress fracture, progression of the bone injury is associated with more constant pain during exercise, eventually leading to cessation of activity. Usually the pain improves with rest; however, pain on any weightbearing, or nocturnal pain, can also occur.

On examination, pain is felt on hopping or jumping on the affected leg. In a tibial stress reaction, a linear area of tenderness will be found on the medial tibial border. If a stress fracture is present the tenderness will be more focal. Diagnosis can often be made based on clinical features.

Some stress reactions or stress fractures have a worse prognosis than others, such as anterior tibial stress fracture seen in ballet dancers. These injuries have higher rates of abnormal healing.

A key differential diagnosis for medial tibial stress syndrome is chronic exertional compartment syndrome—exercise-induced pain involving the deep posterior compartment of the lower leg. See Differential diagnoses for chronic exertional compartment syndrome of the lower leg for a list of potential differential diagnoses for both medial tibial stress syndrome and chronic exertional compartment syndrome. Comparison of the clinical features of chronic exertional compartment syndrome, medial tibial stress reaction and medial tibial stress fracture offers a comparison of the clinical features of chronic exertional compartment syndrome, medial tibial stress reaction and medial tibial stress fracture.