Hello everyone. A month ago I began to get a sharp pain in my lower left shin on the inside where my tibia is. I am a gymnast so I do high impact activity everyday. I tried to ignore the pain, but it wouldn't go away. Then I noticed a divot/bump in the area. It isn't visible to the eye, but if you feel the are you can tell there is a bump. It also feels tender to the touch in the area, but the pain is very localized. I am planning on seeing my school athletic trainer, but I have a feeling she will refer me to a doctor. If i go to a doctor, I know that the fracture will most likely not show up on the x-ray if it is one. Will the doctor give me a boot to wear so that I don't have pain while walking? I have pain in the area when I rest and walk. It's so annoying to have. Any help would be appreciated!
There are several conditions which can cause discomfort over the distal tibia. A stress reaction is one of them.
Stress reactions in a weight bearing bone are a spectrum, from the beginnings of the remodeling of the bone all the way to a frank fracture of the bone.
And, you are correct, that most stress reactions will not show up on an x-ray. However, a stress fracture will, as it is just like a fracture caused from trauma. So, in a true stress fracture, the patient will not be able to bear weight on the bone.
Stress reactions are usually diagnosed with the use of a Technetium-99m bone scan. In this study, the patient is injected with a radio isotope (a tiny amount of material which is actually radioactive). This isotope has a liking for bone, especially bone which is metabolically active (such as where there is a stress reaction, an injury, a growth plate, arthritis, infection, tumor). So, as you can see, a bone scan is sensitive to finding a problem, but not very specific (it can’t tell you exactly what the cause is). But, as with any study, a finding on a study has to be correlated with the patient’s history, symptoms, and physical examination.
If the bump you feel is sort of a mound on the bone (not moveable), then it is most likely a stress reaction. The mound is most likely some new bone formation which the body has laid down over the area which has been weakened due to the remodeling of the bone.
If it is a stress reaction, then usually all that is needed is to decrease activity till the bone has time to remodel and the inflammation has subsided. Then the patient can gradually increase activity again, within the limits of discomfort.
However, there are other things which can cause pain in the distal tibia region. Shin splints, medial tibial syndrome, tendonitis, bursitis, tenosynovitis, etc can all cause discomfort. But, most of these are treated about the same; decreased activity, ice, maintenance of range of motion, maintenance of cardiovascular fitness, and then a gradual return to activity.
Have your trainer check it out. You want to get these things taken care of before they progress to a more advanced problem. Good luck.
Thank you for the help! Do you know any ways I can reduce the pain between the time of my x-ray and when I would get the bone scan? It hurts to walk on this leg. Do you know what the doctor would have me do for that?
If a patient has enough discomfort that it causes a limp, then it is usually recommended that he/she be placed on crutches. The patient does not have to be totally nonweight bearing; just using the crutches to help take some of the stress off of the leg.
Limping can cause problems with other body parts, as it puts more stress on the other leg, the hip, the back, etc.
So, if you have enough pain that you are limping, you probably should be using crutches to walk with. Sometimes, as cane in the hand opposite the hurting leg is enough to allow the patient to walk without a limp.
In terms of medication, usually acetaminophen is about the only thing needed. NSAIDs (such as Motrin, Advil, Aleve, etc) can actually affect bone healing and are usually not recommended in problems such as fractures or stress reactions. You should continue to ice the area when it is really bothering you.