4. Anatomie
M.Soleus
Origo: aput fibulae,prox.1/3deel
facies posterior en margo posterior
fibula, facies posterior tibia aan en
onder linea musculi solei, arcus
tendinous musculi solei
M.Tibialis posterior
Origo: bovenste ¾ van membrana
interossea, aangrenzende delen
tibia en fibula
M.Flexor digitorum longus
Origo: facies posterior tibia distaal
van linea musculi solei, peesarcade
tussen tibia en fibula prox. van
chiasma crurale
M.Tibialis anterior
Origo: prox. tibia uiteinde onder
condylus lateralis, bovenste 2/3
facies lateralis van tibia, fascia
cruris, (membrana interossea)
5. TYPEN
1. Anteriore of laterale shin splints
• pijnlokatie: proximale 1/3 anterolaterale regio tibia
• overbelasting: M.tibialis anterior e.a. anteriore spieren
2. Posteriore of mediale shin splints of Medial tibial stress syndrome (MTSS)
• pijnlokatie: distale 1/3 tibia
• overbelasting: M.tibialis posterior en M.soleus
Whitney W. Lowe – Orthopedic massage 2nd
7. Klinisch
• Periostitis
• Activiteitsgebonden
• Diffuse, zeurende pijn
• 4 graden van pijn:
1. Tijdens activiteit
2. Voor en na activiteit, zonder effect op prestatie
3. Voor, tijdens, en na athletische activiteit, met effect op prestatie
4. Erge pijn m.a.g activiteit niet mogelijk
8. Diagnose
Posteromediaal as
• Anamnese
• Drukpijn med.zijde tibia
• Fysiotherapeutische testen
• one-leg hop test
• X-Ray: normaal
• Botscan: periostitis als lineaire strepen
9. Differentiaal DiagnoseCompartment
Syndrome Shin Splints* Stress Fracture* Tumor
Pain (type) Severe cramping, diffuse pain
and tightness
Diffuse along medial two thirds
of tibial border
Deep, nagging localized with
minimal radiation
Deep, nagging (bone) with
some radiation
Pain with rest Decreases or disappears Decreases or disappears Present, especially night pain Present, often night pain
Pain with activity Increases Increases Present (may increase) Present
Pain with warm-up May increase or become present May disappear Unilateral Unaltered
Range of motion Limited in acute phase Limited Normal Normal
Onset Gradual to sudden Gradual Gradual ?
Altered sensation Sometimes No No Sometimes
Muscle weakness or paralysis Maybe No No Not usually
Stretching Increases pain Increases pain Minimal pain alteration No increase in pain
Radiography Normal Normal Early, negative; late, positive
(?)
Usually positive
Bone scan Negative Periosteal uptake Positive Positive
Pulse Affected sometimes Normal Normal Normal
Palpation Tender, tight compartment Diffuse tenderness Point tenderness Point or diffuse tenderness
Cause Muscle expansion Overuse Overuse ?
Duration and recovery None without surgery None without rest Up to 3 months None without treatment
Table 19-2
Differential Diagnosis of Repetitive Stress Shin Pain
*These two conditions are different stages of tibial stress syndrome
From Magee DJ: Sports physiotherapy manual, Edmonton, 1988, University of Alberta Bookstore.
11. Complicaties
• Stress fracturen
• Maagproblemen door NSAID
Risicofactoren
• Overgewicht (m.n. bij mannen HR 1.5)
• Hyperpronatie
• History of MTSS
• Activiteit: o.a. militairen
N. Reshef et al. 2012
12. Bronnen
• Medial tibial stress syndrome - Reshef N, Guelich DR. 2012
• Shin Splints-Jayson Goo, ATC,MA,CKTI, Melisa Conrad Stoppler, MD,
Chief Medical Editor:2016
• Orthopedic Massage (Second Edition)-Whitney W. Lowe 2009
• David J.Magee, James E.Zachazewski, William S. Quillen
Pathology and intervention in musculoskeletal rehabilitation 2009
• Bohn Stafleu van Loghum. Sobotta Atlas van de menselijke anatomie
2006
Editor's Notes
Superficiale en diepe spieren
Beide door overbelasting
Zelfde etiologie beide typen .
Diffuus=verspreid
Botscan kan negatief zijn in het begin. Maar later postitief. One-leg hip hop test=Eindstandig op 1 been op tenen staan /hinkelen. Test is voor MTSS and a stress fracture: a patient with MTSS can hop at least 10 times on the affected leg where a patient with a stress fracture cannot hop without severe pain