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Medial Tibial Stress Syndrome - Imaging and Differential Diagnosis

Georgi Ivanov, Gergana Angelova, Boyan Balev


Introduction: Medial tibial stress syndrome (MTSS) includes a spectrum of stress injuries that occur at the medial tibia. It is a collective term used to describe numerous  types of lesions with involvement of the tibial bone and can also refer to the earlier manifestations of a tibial stress lesion before an actual fracture component can be identified. Exertional leg pain is the most common manifestation of MTSS and can often be disabling for the patients as well as progress to other serious complications. Therefore, MTSS must be diagnosed and treated properly without excessive invasive procedures.

Materials and Methods: The patients were evaluated with detailed medical history, physical examination and diagnostic imaging studies. Review of all imaging studies – Radiography (Ro) , Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) was performed on a PACS workstation. The literature was systematically reviewed by comparing multiple databases and scientific publications regarding musculoskeletal imaging and diagnostics.

Results: The purpose of this study is to review the various findings of MTSS in different patients and its presentation on different modalities ,thus narrowing down the differential diagnosis of MTSS in the context of its radiographic features.

Conclusions: MTSS has a wide variety of radiological manifestations. The following findings are considered indicative of MTSS: mild osteopaenia, periosteal fluid, marrow oedema, anterior cortex involvement, intracortical signal changes . On the basis of these direct findings no further diagnostic investigations are usually needed. Their role is essential for making the correct diagnosis and precludes the need for invasive procedures, therefore avoiding additional trauma for the patients.


stress fracture, stress trauma, MTSS, traumatology, radiology


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