#845 What is hyperemia in medical imaging of shin splints? - DOC

#845 What is hyperemia in medical imaging of shin splints?

What does hyperemia mean when you see it on an MRI report or an ultrasound report and you have something like Shin splints? Well, good question. That’s what we’re talking about today on the Doc On The Run Podcast.



I recently saw an elite runner who had what he thought was shin splints and one of the findings on the MRI report was hyperemia. And he asked me, of course, what does that mean? Does that mean I have a stress fracture? Does that mean I have shin splints?

Well, good question. We’re going to talk about it so you can understand a little better and hyperemia when you think about it, hyper,  what does hyper mean? It’s too much, right? Too much, simple as that. And what does EMIA mean? Well, EMIA has to do with blood. Right? So, if you think about if you’re anemic, you don’t have enough blood, right? So, you have too little of some kind of blood cells, if you’re anemic. So, hyperemia means you have too much blood flow. Simple as that.

Let’s say let’s think about situation we have something like a tibial stress fracture. You have shin splints, which of course affect your shin and it’s bugging you. Okay, so if you have an MRI, and you think you have shin splints, so let’s say that you have pain in the middle of your shin, you think you have shin splints, you get an MRI. When you get an MRI, what you will see if you have a stress reaction in the bone, but you thought it was shin splints, we actually have a stress reaction is that right where you have all that pain, you will have a huge amount of inflammatory fluid and increased blood flow in the bone right there. And that it doesn’t show up red on an MRI, it shows up as bright white, it’s lit up, as we say, and you have way too much blood flow going on in there.

What’s the problem with that? Well, first of all, you have to have blood flow to get things to heal, right? You have to have blood flow to get nutrients and you have to have blood flow to get garbage out. So, if you have damaged tissue that needs to be removed, that’s how you get it there. The highway for healing is blood flow. Too much blood flow is a bad thing. Why? It actually washes out the calcium and it decreases the bone density.

If you ignore this hyperemia, if you ignore the increased blood flow that’s on your MRI and you don’t do something about it, then eventually it will crack and where you have all that hyperemia then you actually get a crack in the bone. Now, you have a real tibial stress fracture, which is a real problem. You can see this another way too and you don’t have to have an MRI in order to see this because if you have a concern that you’ve got maybe a tibial stress fracture or you think maybe it’s shin splints, well we can use ultrasound.

I take an ultrasound probe and put it on your leg with a bunch of gel and I’ll look at it. So, I’m looking at the bone and what do I see? Well, the thing that I see that will suggest this, the hyperemia part is that on a color doppler, you may see this little splotchy sort of streaking things where you actually see increased blood flow in the bone. You can actually see increased blood flow and increased blood flow around and in the bone actually means too much blood flow. If it’s focal in if it’s in the place that you’ve had pain. So, you have pain here, obviously you and you see this on MRI, that’s bad if you have pain here, and you see on color doppler, the increased blood flow in the bone.

That’s bad, because again, the increase blood flow number one tells you there’s problem. Your body’s trying to fix something. You have to address it and if you ignore it, it will keep doing it and if you keep applying the stress that’s stimulating that increase in blood flow, but what happens is that over time, it washes out the calcium, it decreases the bone density, you get what we call focal osteopenia, meaning in one spot, the bones getting weaker, and then the bone cracked and you actually get a real stress fracture.

So, that’s what it really . In MRI, the early stages of focal hyperemia and bone marrow edema actually correlates with the beginning stages of osseous resorption or decreasing bone density that will lead to micro fractures. On ultrasound, the increase in that Doppler flow in the periosteum or the covering the bone is what we see as hyperemia or too much blood flow also sometimes called hyper vascularity. Again, just a fancy term for too much blood flow. That’s what it is, and you need to pay attention to it, and you shouldn’t ignore it. So, if your doctor brings it up, figure out how to fix it.

If you want to learn more about the strategies and the frameworks, I use with injured runners who have stress fractures and want to continue working out and want to make sure they can get back to running and return to running as strong as possible. Come check it out. You can sign up for free, it’s at www.docontherun.com/stressfracturemasterclass. So go sign up and I’ll see you in the training.