Medial tibial stress syndrome: A skeleton from medieval Rhodes demonstrates the appearance of the bone surface – a case report

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2014.942587 We present a case of bilateral medial tibia stress syndrome (MTSS) in a 500to 800-year-old male skeleton with an estimated age at death of between 20 and 30 years. The skeleton came from a Byzantine graveyard in Rhodes, Greece, which was in use between the thirteenth and fifteenth centuries AD. The tibiae exhibit symmetrically developed surface lesions along the posterior-medial aspects involving the middle and distal thirds of diaphyses, in accordance with the pattern of symptom distribution in MTSS. The lesions comprise longitudinal striation and associated pitting, mainly affecting the mid-diaphyses and posterior-medial borders and in finely porous, diffuse tissue predominantly over the distal diaphyses (Figure 1). Cortical lesions are more prominent in the left tibia while corresponding sites over the right tibia exhibit excessive cortical tissue deposition resulting in an overall robust morphology (Figure 2). Additionally, there are bilateral focal erosions and osteophytes on distal articular surfaces (Figure 3) (Jurmain and Kilgore 1995, Ortner 2003). Conventional radiographs confirm the expanded cortical component and disturbed outline along the posterior-medial aspect of the distal left tibia and further reveal the sclerotic distal articular surface, whereas the right tibia shows thickened cortex, markedly increased along the anterior border (Figure 4).