Current RMA Instruments:

Changes from Previous Instruments:

SOP Bulletin 179

ICD Coding:

• ICD-9-CM Codes: 729.7
• ICD-10-AM Codes: M76.8

Brief description:

Shin splints generally refers to pain along the inner aspect of the shin bone (tibia).

The RMA SOP covers two specific conditions (only):

1. Medial tibial stress syndrome: This is the classical shin splints associated with running and other lower limb activities.  It results from bone stress or inflammation of the layer covering the bone (periostium) and causes pain in the lower two-thirds of the inner aspect of the tibia.

2. Chronic exertional compartment syndrome of the lower leg. A compartment is a group of muscles, nerves and blood vessels surounded by a tough membrane (fascia) that does not stretch easily.  Increased pressure in a compartment associated with activity (e.g. running) can impair blood flow and cause pain in the calf or shin.

Confirming the diagnosis

1. Medial tibial stress syndrome – This diagnosis is based on clinical symptoms.  Confirmation may require radionucleotide bone scan or MRI [magnetic resonance imaging] scan.

2. Chronic exertional compartment syndrome - This diagnosis is based on clinical symptoms. Confirmation can involve muscle compartment pressure testing or a radionucleotide compartment pressure study.

The relevant medical specialist is an orthopaedic surgeon.

Additional diagnoses covered by SOP

• Medial tibial stress syndrome
• Chronic exertional compartment syndrome of the lower leg
• Periostitis (tibial)
• May also be referred to as anterior tibial (pain) syndrome, medial tibial syndrome and anterior or posterior compartment syndrome (chronic)

Conditions not covered by SOP

• Acute compartment syndrome^#
• Atherosclerotic peripheral vascular disease*
• Compartment syndrome of other parts of the body – upper arm, forearm, hand, thigh, and foot^#
• Iliotibial band syndrome*
• Myelopathy^# or lower limb radiculopathy^#
• Nerve entrapments^#
• Periostitis or enthesitis of other parts of the body
• Stress fracture of the tibia or the fibula* - Fracture SOP
• Tendinopathy of the flexor or extensor tendons of the lower leg and ankle.

* another SOP applies  - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

Clinical onset will date from when relevant, continuing symptoms, subsequently confirmed to be due to shin splints, first developed.   Shin splints can resolve completely and redevelop at a later date.  If there has been a substantial symptom free period (e.g. > 1 year) between episodes then a new symptom episode is likely to represent a new clinical onset.  An underlying propensity to develop the condition with activity may be present but there may be no residual pathology between episodes.  Onset of compartment syndrome in someone who previously had medial tibial stress syndrome (and vice versa) would represent a new onset, not  a worsening of the previous condition. 

Clinical worsening

A permanent clinical worsening of medial tibial stress syndrome would be difficult to demonstrate, as the condition will improve with reduction/cessation of the activities that brought it on.  Development of a stress fracture is a new onset of that condition (fracture SOP) not a worsening of shin splints.  Chronic exertional compartment syndrome, similarly, will respond to conservative treatment and rest/reduced activity.  Surgery (elective fasciotomy) may be required in severe cases.  Acute compartment syndrome, requiring emergency surgery, is a separate condition that is not covered by the SOP and it does not represent a worsening of shin splints.