We have reviewed retrospectively 4 patients,
with a total of eight tibias.
All MRI examinations were performed on 1.5 Tesla MR (Intera and Achieva,
Philips Medical Systems) using a phased array coil.
Gadolinium was not necessary.
The patients were positioned in a supine neutral position.
Both tibias were imaged regardless of symptoms.
Axial T1W (TR/TE 500/18; NEX 2; matrix 468 x 252; slice thickness5 mm; FOV 400 x 200 x293 mm) and T2W FSE (TR/TE 4024/30; NEX 2; matrix 432 x 139; slice thickness 6 mm; FOV 400 x 180 x 250 mm) sequences were obtained.
Also T2W-PD with fat suppression sequence.
In the coronal plane T1W (TR/TE 536/10; NEX 2; matrix 360 x 335; slice thickness 5 mm; FOV 360 x 420 x 150 mm) and STIR (TR/TE 3599/30; inversion time 140 ms; NEX 4; matrix 244 x 200; slice thickness 5 mm; FOV 360 x 407 x 149 mm) sequences were obtained.
Our four patients presented with selective pain and tenderness showing some alteration at MRI.
They had not a clinical suspicion of “shin splints syndrome”.
Faced with this type of selected pain on the anterior region of the tibia,
it becomes necessary to evaluate the tissue signal of that area.
The radiologist should be aware looking for slight soft tissue and bone anomalies.
The anteromedial region of the leg,
by reference to the tibia,
is covered only by subcutaneous tissue fat and skin.
Against,
the anterolateral region presents some muscles between the tibia and fibula,
from medial to lateral the anterior tibial muscle,
the extensor digitorum longus,
the extensor hallucis longus deep to previous,
fibularis brevis and fibularis longus.
The posterior leg (less commonly affected) has a lot of muscles compared to the anterior: superficially,
soleus and gastrocnemius muscles and plantaris tendon,
and deeply from medial to lateral,
the flexor digitorum longus,
the tibialis posterior and the flexor hallucis longus.
Then,
knowing that stress injury is a pathology that can affect the entire perimeter of the bone,
the tibia can be divided,
according to the axial plane and using two orthogonal crossing lines,
into four regions: anterior,
posterior,
medial and lateral.
These are important in describing the periosteal edema location.
According its length,
the tibia is divided into proximal (epiphysis and metaphysis),
diaphysis and distal tibia (distal metaphysis and epiphysis).
In this review we have focused on the key findings of "shin splints" such as periosteal and bone marrow edema.
The edema is better evaluated on STIR and T2 with fat suppression images.
The axial plane is sufficient to quantify the degree of edema and longitudinal plane (coronal or sagittal),
to assess its extension.
So the radiologist may review the regional anatomy from the surface (subcutaneous tissue fat),
intermediate layer (muscles) to the periosteum and bone,
including bone marrow.