Medialt tibialt stressyndrom - en oversikt

The objective of this thesis is to give a thorough presentation of medial tibial stress syndrome (MTSS) with emphasis on pathophysiology, aetiology, diagnostics and treatment options. MTSS is one of the most common exercise induced overuse injuries in athletes and military personnel. It is defined as exercise induced pain along a segment of at least 5 cm localized to the distal 2/3 of the posteromedial border of the tibia. The pathophysiological mechanisms of this condition is disputed. A traction induced periostitis has long been proposed as the mechanism of injury, whereas recent studies claim the condition to be caused by shear forces due to repetitive bending of the tibia causing stress to the cortical bone with subsequent microfractures. Pronated foot posture, female gender and high BMI are well documented risk factors for acquiring MTSS. Among the different imaging modalities MRI is the most sensitive in the acute phase, which can prove useful in differentiating between MTSS and tibial stress fractures where the latter require a different treatment strategy. T2 weighted fat suppressed MRI could reveal a subperiostal oedema on the medial tibial border, and in more severe cases bone marrow oedema. There is no evidence proving existing treatment options superior to rest alone. As a preventive measure, shock absorbing insoles have a well documented effect