Changes from Previous Instruments:

ICD Coding:

• ICD-10-AM Codes: M76.8

Brief description:

Medial tibial stress syndrome (shin splints) is one of the most common causes of exercise induced lower leg pain. It is a condition that causes pain along the inner edge of the shin bone (lower two-thirds of the tibia) and commonly affects runners as well as those participating in other sports that involves running and jumping. Symptoms develop as a result of bone stress and/or inflammation of the layer covering the bone (periostium).

Confirming the diagnosis

The diagnosis of medial tibial stress syndrome is based on the characteristic history and examination findings. Radiological imaging (X-ray, CT, MRI, bone scan) may be useful to confirm the pathology or to rule out other possible causes. However, imaging is not required to adequately establish the diagnosis. 

The relevant medical specialists include General Practitioners and Orthopaedic Surgeons.

Additional diagnoses covered by SOP​

• Periostitis (tibial)
• Tibial stress syndrome
• Anterior shin splints
• Posterior shin splints

Conditions not covered by SOP

• Chronic exertional compartment syndrome of the lower leg *
• 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 #
• Popliteal artery entrapment syndrome *
• Nerve entrapments (sural or superficial peroneal) #
• 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
• Vascular insufficiency * - Chronic venous insufficiency of the lower limb and varicose veins of the lower limb SOP

* 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. 

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. Surgery (elective fasciotomy) may be required in severe cases.