Injection therapy for medial tibial stress syndrome

NewsBot · Nov 15, 2011

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The effectiveness of prolotherapy for recalcitrant medial tibial stress syndrome: a prospective case series
N Padhiar, P R Jones, M Curtin, P Malliaras, O Chan, T A Crisp
Br J Sports Med 2011;45:A16

The aim was to evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant medial tibial stress syndrome (MTSS) decreases pain and facilitates a return to desired activity levels. This was a prospective case series. Participants were nine subjects: seven male and two female; (mean age=33.6 years) with MTSS, referred from sports injury clinics across the UK to a specialist centre at a London private hospital, having failed conservative treatment. An ultrasound-guided subperiosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically 1 ml of solution was injected per cm of symptomatic area. A second injection was subsequently administered at four weeks for 4 of the 9 subjects. Pain was assessed using a 10 cm visual analogue scale (VAS) at baseline, short-term, medium-term (mean 18 weeks) and at long-term (mean 1 year) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium-term and long-term follow-up. Subjects reported a significant (p<0.01) reduction in median VAS pain score at medium-term follow-up compared to baseline. Median improvement per subject was 5/10. At long-term follow-up, median improvement was 4/10. Subjects rated their condition as ‘much improved' at medium-term follow-up and ‘no change' at long-term follow-up. Median return to sport score at medium-term follow-up was ‘returned to desired but not preinjury level' and ‘returned to sport at an unsatisfactory level' at long-term follow-up. There were no reported adverse events. Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. There is a suggestion that this benefit may be maintained long-term. More robust trials are required to validate these findings.
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NewsBot · Mar 4, 2014

Re: Prolotherapy for recalcitrant medial tibial stress syndrome

LOCAL MULTIPUNCTUAL CORTICOSTEROID INJECTIONS FOR MEDIAL TIBIAL STRESS SYNDROME: A NOVEL APPROACH
Medina I, Jurado A, Magee DJ, Vas J
Rev.Ib.CC. Act. Fis. Dep. 2013; 2 (3):22-27

Medial stress tibial syndrome (MTSS) has been and remains one of the most common pathologic conditions of the lower extremity. The results of conventional therapies for this condition have been inconsistent. Local corticosteroid injection has been shown to have favourable effects in treating musculoskeletal disorders. The effect of local multipunctual injections of a corticosteroid combined with an anaesthetic was studied in 47 patients (29 male and 18 female subjects, with an average age of 23.8 years) with MTSS. Direct consultation and examination was used to assess outcome. Patients were evaluated once a week after first injection for the first 4 weeks, and 3 months after treatment as well. Level of symptoms-free activity was recorded for each patient. The outcomes of the multipunctual injections were determined by comparing preintervention and posintervention level of symptoms-free activity and ability of the athletes to return to presymptom levels of exercise. The results suggest that the treatment reduces the recovery time and improves functional outcomes.
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NewsBot · Jul 21, 2015

Atrophy and Depigmentation After Pretibial Corticosteroid Injection for Medial Tibial Stress Syndrome: Two Case Reports.
Loopik MF, Winters M, Moen MH.
J Sport Rehabil. 2015 Jul 13

INTRODUCTION:
No reports have been published on the results of corticosteroid injections for medial tibial stress syndrome (MTSS).
CASE PRESENTATION:
We present two cases of women with MTSS who showed atrophy and depigmentation of the skin after pretibial corticosteroid injections. Case 1 is an 18-year-old woman presenting with pain in her lower leg for twelve months. No improvement was noticed after conservative treatment. Therefore she received local injections with corticosteroids. Five months later physical examination showed tissue atrophy and depigmentation around the injection sites. Case 2 is a 22-year-old woman, who presented with pain in both lower legs since for twenty-four months. Several conservative treatment options failed therefore she received local injections with corticosteroids. Physical examination revealed tissue atrophy and depigmentation around the injection sites.
CONCLUSION:
We found no positive effect of injections with corticosteroids in two cases of MTSS. Furthermore, considerable tissue atrophy and hypopigmentation of the skin was observed.
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NewsBot · Jun 17, 2020

The Effectiveness of Prolotherapy for Recalcitrant Medial Tibial Stress Syndrome: A Prospective Case Series
Nat Padhiar, Mark Curtin, Osama Aweid, Bashaar Awied, Dylan Morrissey, Otto Chan, Peter Malliaras, Tom Crisp
Research Square

Background: Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6%-16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degree of success. In recalcitrant cases, surgery is often the only option.

Objective: To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant Medial Tibial Stress Syndrome decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up sport.

Design: Prospective case series

Setting: Private specialist Centre

Patients: Eighteen patients: fifteen male and three female; (mean age=31.2 years) with MTSS were referred from sports injury clinics across the UK, having failed all available conservative treatment.

Intervention: An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of symptomatic area.

Main Outcome Measures: Pain was assessed using a 10-cm visual analogue scale (VAS) at baseline, short-term, medium-term (mean 18 weeks) and long-term (mean one year) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up.

Results: Patients reported a significant (p<0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and median return to sport score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported.

Conclusions: Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term. More robust trials are required to validate these findings.

Clinical Relevance: Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant Medial Tibial Stress Syndrome.
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NewsBot · Aug 16, 2020

Successful Treatment of Medial Tibial Stress Syndrome with Interosseous Membrane Acupuncture: A Case Series
David Lee Riegleman and Julie A. Creech
6 Aug 2020

Background: Medial tibial stress syndrome (MTSS), otherwise known as shin splints, frequently causes pain and disability in the physically active population and can be recalcitrant to treatment. Interventional and alternative therapies, specifically acupuncture, for treatment of MTSS have been poorly described in the literature. The aim of this case series is to describe an acupuncture technique for the treatment of MTSS.

Cases: Patients who received the diagnosis of MTSS were treated in an outpatient military treatment facility. One Hwato® 0.30 mm × 75 mm needle was placed 1 cun distal and 1 cun lateral to the tibial tuberosity of the affected leg and was inserted deeply through the plane of the interosseous membrane. A second needle was then placed 2 cun distal to the first needle in the same trajectory and at the same depth. Needles were then irregularly stimulated for 5 minutes before needle removal. After treatment, the patient vigorously moved the affected leg before reassessing pain.

Results: Both patients noted a clinically significant decrease in pain immediately after intervention, which lasted for 4 weeks.

Conclusions: Interosseous membrane acupuncture is a clinically significant, effective means to decrease MTSS-associated pain in physically active adults. This case series demonstrates a technique to augment conservative therapy of patients with MTSS.
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NewsBot · Jan 25, 2021

The Effectiveness of Prolotherapy for Recalcitrant Medial Tibial Stress Syndrome: a Prospective Consecutive Case Series.
Padhiar N, Curtin M, Aweid O, Awied B, Morrissey D, Chan O, Malliaras P, Crisp T
Preprint from Research Square, 13 Jan 2021

Background:
Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6%-16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option.
Objective:
To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport. Method: The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age=31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment. Intervention: An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area. Main Outcome Measures: Pain was assessed using a 10-cm visual analog scale (VAS) at baseline, short-term, medium-term (mean 18 weeks), and long-term (mean 52 weeks) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro-Wilk test was used to evaluate the normality of the distribution of data. Friedman's non-parametric test was used to compare the within-patient treatment response over time. Post-hoc Wilcoxon signed-rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods.
Result:
s: Patients reported a significant ( p <0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as 'much improved' at medium-term follow-up and the median return to sports score was 'returned to desired but not pre-injury level' at medium-term and long-term follow-up. No adverse events were reported.
Conclusions:
Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term; however, more robust trials are required to validate these findings in the absence of controls. Clinical Relevance: Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant MTSS.
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NewsBot · Apr 18, 2021

The effectiveness of PROLOTHERAPY for recalcitrant Medial TIBIAL Stress Syndrome: a prospective consecutive CASE series
Nat Padhiar, Mark Curtin, Osama Aweid, Bashaar Aweid, Dylan Morrissey, Otto Chan, Peter Malliaras & Tom Crisp
Journal of Foot and Ankle Research volume 14, Article number: 32 (2021)

Background
Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6 and 16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option.

Objective
To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport.

Method
The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age = 31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment.

Intervention
An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area.

Main outcome measures
Pain was assessed using a 10-cm visual analog scale (VAS) at baseline, short-term, medium-term (mean 18 weeks), and long-term (mean 52 weeks) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro-Wilk test was used to evaluate the normality of the distribution of data. Friedman’s non-parametric test was used to compare the within-patient treatment response over time. Post-hoc Wilcoxon signed-rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods.

Results
Patients reported a significant (p < 0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and the median return to sports score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported.

Conclusions
Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term; however, more robust trials are required to validate these findings in the absence of controls.
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