Update on Medial Tibial Stress Syndrome

Revista Cientifica General Jose Maria Cordova

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Title Update on Medial Tibial Stress Syndrome
Actualización sobre el síndrome de estrés tibial medial
Mise à jour du syndrome de stress du tibia médial
Atualização sobre a síndrome do estresse tibial medial
 
Creator Gómez García, Santiago
 
Subject Medial tibial stress syndrome
shin splints
leg pain
Síndrome de estrés tibial medial
periostitis tibial
dolor en pierna
Sydrome de stress du tibia médial
périostite tibial
douleur à la jambe
síndrome do estresse tibial medial
periostite tibial
dor nas pernas
 
Description Medial tibial stress syndrome is one of the most common causes of pain induced by exercise in the lower extremities among practitioners of physical activities and sports. It is a semiotic event produced by repetitive injury of mechanical stress on the medial aspect of the tibia, frequent among the diseases that affect runners and military training; not usually serious, but if not treated properly it can evolve to disabling injuries such as the stress fracture of the tibia. There are risk factors that contribute to the development of the pathology among which include the type of activity, inadequate training techniques, soil conditions, and the type of footwear used, also abnormal pronation of the subtalar joint, the female sex, a high body mass index, and decreased bone mineral density. The diagnosis is usually established through history and physical examination due to X-rays not providing useful information, they only help to establish the differential diagnosis with stress fractures of the tibia and more expensive radiological exams are not justified. The recovery time for those affected by this disease is quite prolonged, and there is the tendency to quit the therapy, preventing the achievement of the proposed therapeutic objectives, the gold standard treatment is physical therapy, however there are other therapeutic modalities with great prospects for the treatment of this nosologic entity, in which Extracorporeal Shock Wave Therapy excels, and although there are scientific studies in this subject, there are not enough. Both the pathophysiology, and the prevention and treatment are still unclear. Due to the above, a review of the state of the art of the fundamental aspects of this pathology is performed.
El síndrome de estrés tibial medial, SETM, una de las causas más comunes de dolor inducido por el ejercicio en las extremidades inferiores entre los practicantes de actividad física y deporte, como corredores y militares en formación, es un evento semiológico producido por lesiones repetitivas de estrés mecánico en la región medial de la tibia. No suele revestir gravedad, pero si no se trata adecuadamente puede evolucionar a lesiones incapacitantes, como la llamada fractura por estrés de la tibia. Existen factores de riesgo que contribuyen al desarrollo de la patología entre los que cabe mencionar el tipo de actividad, las inadecuadas técnicas de entrenamiento, las condiciones del terreno y el tipo de calzado utilizado, también la pronación anormal de la articulación subastragalina, el sexo femenino, un índice de masa corporal elevado, así como la disminución de la densidad mineral ósea. El diagnóstico generalmente se establece a través del interrogatorio y el examen físico, ya que las radiografías solo sirven para descartar fracturas por estrés de la tibia, y exámenes de imágenes más costosos no se justifican.  El tiempo de recuperación de los afectados por esta patología es bastante prolongado, lo que propicia la tendencia al abandono del tratamiento y, así, desfavorece la consecución de los objetivos terapéuticos propuestos. El tratamiento estándar de oro es la terapia física; sin embargo, existen otras modalidades terapéuticas con prometedoras perspectivas, entre las que sobresale la terapia por ondas de choque extracorpóreas, respecto de la cual los estudios disponibles son todavía insuficientes, pues tanto la fisiopatología del SETM, como su prevención y su tratamiento aún no están claros. En atención a lo anteriormente expuesto, este artículo presenta una revisión del estado del arte de los aspectos fundamentales de la patología. 
Le Syndrome tibial médial d’effort (STME) est l’expression la plus répandue de douleur induit par l’exercice  dans les membres inférieurs entre les groupes d’adeptes d’activité physique et de sport, comme des athlètes et des militaires au processus éducatif. Il a la même valeur sémiologique que les douleurs occasionnées par des gestes répétitifs de stress mécanique dans la región médial du tibia. Il ne semble pas grave, mais s’il n’est pas traitée de manière adéquate, il peut entraîner des lésions invalidantes telles que fractures de stress du tibia. Il existe plusieurs facteurs de risque qui pourraient déclencher cette pathologie, parmi lesquels figurent le type d’activité, les tecniques d’entraînement inadaptées, les conditions géographiques et le type de chaussures utilisées et également la pronation anormale de l’articulation subastragalienne, le sexe féminin, un indice de masse corporelle élevée, ainsi que la diminution de la densité minérale osseuse. Le diagnostic est généralement basé sur l’interrogatoire et l’examen physique, parce que les radiographies ne servent qu’à écarter l›existence fractures de stress du tibia et des examens radiographiques plus coûteux qui ne se justifient pas. Le délai de récupération des malades de cette pathologie peut être assez long, ce qui mène à la tendance à l’abandon du traitement de telle façon que cela défavorise la réalisation des objectifs thérapeutiques proposés. Le traitement standard le plus accueilli est la thérapie physique. Toutefois, Il existe également d’autres instruments thérapeutiques, avec des perspectives prometteuses de succès, parmi lesquelles ressort la thérapie par onde de choc extracorporelles, dans laquelle les résultats des études disponibles sont à ce jour insuffisants, car tant la physiopathologie du STME que sa prévention et sa traitement sont encore flous. Compte tenu de ce qui précède, cet article présentent une révision de l’état de la technique des éléments fondamentaux de la pathologie. 
A síndrome do estresse tibial medial, SETM, é uma das causas mais comuns de dor induzida pelo exercício nas extremidades inferiores entre os praticantes de atividade física e esporte, como atletas e estudantes da carreira militar, é um evento semiológico produzido por lesões repetitivas de estresse mecânico na face medial da tíbia. Normalmente não é sério, mas se não tratada adequadamente pode evoluir para lesões incapacitantes, como a fratura por estresse da tíbia. Existem fatores de risco que contribuem para o desenvolvimento da patologia entre os quais incluem o tipo de actividade, as técnicas de treinamento inadequadas, as condições do solo e o tipo de calçado utilizado, também a pronação anormal da articulação subtalar, o sexo feminino, maior índice de massa corporal e diminuição da densidade mineral óssea. O diagnóstico geralmente é estabelecido pela história e exame físico, raios-X só servem para excluir as fraturas por estresse da tíbia, e não justifica exames de imagens mais caros. O tempo de recuperação para as pessoas afectadas por esta doença é bastante longo, o que incentiva a tendência a abandonar o tratamento e, assim, desencoraja alcançar objetivos terapêuticos propostos. O tratamento padrão-ouro é a terapia física; no entanto, existem outras modalidades terapêuticas com perspectivas promissoras, entre as quais destaca-se o tratamento com ondas de choque extracorporal, para o qual os estudos disponíveis ainda são insuficientes, uma vez que tanto a fisiopatologia da síndrome como sua prevenção e tratamento ainda não são claras. Em vista do acima exposto, o artigo apresenta uma revisão do estado da arte dos aspectos fundamentais da patologia. 
 
Publisher Sello Editorial ESMIC - Escuela Militar de Cadetes "General José María Córdova"
 
Date 2016-01-30
 
Type info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
Peer-reviewed article
Articulo revisado por pares
 
Format application/pdf
 
Identifier https://revistacientificaesmic.com/index.php/esmic/article/view/13
10.21830/19006586.13
 
Source Revista Cientifica General Jose Maria Cordova; Vol 14 No 17 (2016): Military science; 225-242
Revista Científica General José María Córdova; Vol. 14 Núm. 17 (2016): Ciencias militares; 225-242
Revista Científica General José María Córdova; Vol. 14 No 17 (2016): Ciencias militares; 225-242
Revista Científica General José María Córdova; v. 14 n. 17 (2016): Ciencias militares; 225-242
2500-7645
1900-6586
 
Language spa
 
Relation https://revistacientificaesmic.com/index.php/esmic/article/view/13/501
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Rights Derechos de autor 2016 Revista Científica General José María Córdova
 

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