Differential Diagnosis for MRI Findings

The provided MRI findings describe a curvilinear subperiosteal high signal change between the periosteum and underlying cortex of the proximal tibia, periosteal avulsion injury associated with contusions, injury to the tibia and fibula, partial tear involving the tibialis posterior, and contusion injury of the adjacent soleus muscle. Based on these findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Shin Splints (Medial Tibial Stress Syndrome): This condition is characterized by pain and inflammation in the lower leg, typically due to overuse or repetitive stress on the tibia. The described MRI findings, including periosteal reaction and edema, are consistent with shin splints, especially given the involvement of the proximal tibia and the presence of a partial tear in the tibialis posterior, which could be secondary to chronic stress and inflammation.

• Other Likely Diagnoses

  • Stress Fracture: The presence of a periosteal avulsion injury and high signal changes on MRI could also suggest a stress fracture, particularly if there's a history of increased physical activity or repetitive stress on the lower limbs.
  • Periostitis: Inflammation of the periosteum, which could be due to various causes including infection, trauma, or systemic diseases, might present with similar MRI findings.
  • Muscle Strain or Contusion: The partial tear of the tibialis posterior and contusion of the soleus muscle could be part of a broader spectrum of muscle injuries in the lower leg, possibly due to direct trauma or overuse.

• Do Not Miss Diagnoses

  • Osteomyelitis: Although less likely, an infection of the bone (osteomyelitis) could present with periosteal reaction and edema on MRI. Missing this diagnosis could lead to severe consequences, including bone destruction and systemic infection.
  • Ewing's Sarcoma or Other Bone Tumors: These conditions can cause periosteal reaction and might present with similar MRI findings. Early detection is crucial for effective treatment and prognosis.
  • Compartment Syndrome: Especially if there's significant swelling or pain out of proportion to the injury, compartment syndrome should be considered, as it is a medical emergency requiring prompt intervention.

• Rare Diagnoses

  • Hypertrophic Osteoarthropathy: A rare condition characterized by periosteal new bone formation, which could potentially present with similar MRI findings, although it is typically associated with other systemic symptoms.
  • Sickle Cell Disease Crisis: In patients with sickle cell disease, a crisis can lead to bone infarcts and periosteal reaction, which might appear similar to the described MRI findings.