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IMAGE INTERPRETATION · BONE IMAGING

Shin Splints on Bone Scan: Medial Tibial Stress Syndrome

Tc-99m MDP bone scan showing uptake in the tibial region
Tc-99m MDP bone scan showing uptake in the tibial region

CC BY 4.0 · Santiago et al. / Wikimedia Commons · source file

Question

A bone scan of a distance runner with medial lower leg pain shows a linear band of mildly increased uptake along the posteromedial cortex of the tibia, extending over a long segment. This pattern is most consistent with:

  1. AMedial tibial stress syndrome (shin splints)
  2. BComplete tibial stress fracture
  3. CTibial osteosarcoma
  4. DOsteomyelitis of the tibia
Show the answer and explanation

A. Medial tibial stress syndrome (shin splints)

Medial tibial stress syndrome (MTSS, 'shin splints') produces a characteristic longitudinal band of mildly increased uptake along the posteromedial cortex of the tibia on bone scan, representing periosteal stress reaction over a long segment. This distinguishes it from a stress fracture, which shows a more focal, fusiform, transverse focus of intense uptake at the cortex. MTSS uptake is also typically less intense than a true stress fracture. The three-phase bone scan shows no significant flow or blood pool abnormality in MTSS (unlike stress fracture or osteomyelitis).

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