The diagnosis of shin splints typically relies upon a patient’s medical history and physical examination. Imaging tests may be used to distinguish between shin splints and stress fractures if clinical discoveries are not conclusive.

When collecting a patient’s medical history, a physician will ask about the patient’s symptoms and athletic activities. Information on training patterns and running experience, including weekly mileage, may be requested. The physician may also inspect the patient’s footwear. The patient may be asked to complete a pain assessment, a process in which pain is evaluated to determine its symptoms, severity and possible causes. For more information, see pain assessment.

A physical examination for shin splints will begin with an evaluation of the patient’s signs and symptoms. The physician will look for tenderness, swelling and induration (hardening of the soft tissues) along the shin, both by visual observation and feeling (palpating) the leg. The patient’s gait (manner of walking), both when walking and running, and joint alignment will typically be evaluated. Muscle strength, balance and flexibility will generally be tested. The physician will note any gait disturbances.

Shin splints are common but not the only problem that produces similar symptoms. An important part of diagnosis is the exclusion of other possible sources of leg pain, including:

• Stress fracture. Another common sports injury where a tiny crack forms in the bone due to overuse. Stress fractures and shin splints are easily confused. In a stress fracture, however, the pain is much more localized, typically in the middle of the tibia (shinbone) directly over the bone. Stress fractures are more serious than shin splints and require a greater restriction of activity.
  
  
• Compartment syndrome. Pain and swelling from increased tissue pressure in a muscle, typically hindering local circulation and neuromuscular function. Sensory or motor nerve deficits and pain out of proportion with clinical findings generally suggest compartment syndrome. However, some physicians consider shin splint to be a mild form of this condition.
  
  
• Osgood-Schlatter disease. A condition marked by swelling, tenderness and shin pain. Unlike typical shin splints, however, the symptoms are felt just below the knee. Osgood-Schlatter disease is most common in children engaged in sports that involve jumping, kicking or running.

For most patients, the diagnosis of shin splints can be made based on the patient’s history and the physical exam. However, if the physician is unsure of the cause of the patient’s symptoms and suspects that a stress fracture or other disorder may be present, imaging tests will typically be ordered. These tests may include:

• X-ray. These are normal in patients with shin splints. However, they may also be normal with stress fractures, which usually do not show on x-ray for two to three weeks after the initial pain. After this time, the physician may note changes to the periosteum (membrane covering the bone).
  
  
• Bone scan. This form of radionuclide imaging may show bone changes in both shin splints and stress fractures within a few days. In shin splints, the injected substance does not accumulate in a localized area, but typically accumulates along the length of the tibia (shinbone). In stress fractures, the substance accumulates focally around the area of the fracture. Bone scans may also display inflammation of the periosteum.
  
  
• MRI (magnetic resonance imaging). These imaging tests using powerful magnets have become increasingly popular in the evaluation of lower limb injuries in sports medicine. In stress fractures, MRI demonstrates an abnormally wide signal localized to the bone marrow. These changes may be noted earlier than x-ray changes. A shin splints MRI, however, does not show this bone marrow signal. Instead, a narrower signal is demonstrated along or within the tibia. MRI may also demonstrate inflammation in the periosteum and tiny tears in the muscles or ligaments.