CT reveals cortical abnormalities in runners with tibial stress syndrome


NEW YORK (Reuters Health), Oct 11 - High-resolution CT scans reveal tibial cortical abnormalities that precede the onset of pain in distance runners, according to a report in the September American Journal of Roentgenology.

Medial tibial stress syndrome ("shin splints") accounts for more than one in 7 running injuries, the authors explain, but whether symptoms result from or precede tibial bone mineral density loss remains unclear.

Dr. Michele Gaeta and colleagues from University of Messina, Italy, investigated whether CT abnormalities occurred in the absence of symptoms in distance runners and whether CT findings could accurately distinguish between asymptomatic and symptomatic runners.

All tibias classified as normal by high-resolution CT were painless, the authors report, as were all tibias showing small, scattered areas of slightly reduced cortical attenuation without clear findings of osteopenia.

Fourteen of 22 tibias showing cortical osteopenia, striations, or both were painful, the results indicate, including 14 of 14 painful tibias and eight of 48 painless tibias in distance runners.

High-resolution CT was 100% sensitive, 88.2% specific, and 90.2% accurate in predicting the presence of pain, the researchers note.

"Our results showed that bone osteoporosis and resorption cavities can be found in asymptomatic athletes," the authors conclude. "On the other hand, no patient with medial tibial stress syndrome had normal tibial cortex. We think this is evidence that bone remodeling always precedes pain and therefore is highly probable that it is the cause of symptoms."

"Although agreement is growing that MRI is the best technique for the assessment of stress injuries to bone," the investigators add, "we think that CT can be a useful imaging tool both in clinical and in research approaches to this pathophysiologic entity."

Last Updated: 2006-10-11 11:25:36 -0400 (Reuters Health)

AJR Am J Roentgenol 2006;187:789-793.

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