Pain and swelling in the shin after a direct trauma during a soccer game

Patient

Q: Hi, i played soccer yesterday and got hit in the tibia..after 15min the swelling was big, but finish the game with little pain..went home and pain was severe that i barely walk..this morning i can walk but can't hop on affected leg, 'cause i heard for this one leg hop test which would mean that it is strees fracture of the tibia not medial tibia stress syndrome..do i need to have bone scan,CT or MRI?is it necessary to do these images because in most cases surgery isn't required,just RICE regime..and what about NSAID,calcium rich food ,exercising muscles except affected leg?

Doctor

A:   You sustained a harsh contusion in the tibia that is producing now severe pain in the shin area, but if besides the pain you also have the area red, warm, the swelling is getting worse and the pain persists during rest or do not ease with ice and over-the-counter pain relievers, then I strongly recommend you to consult your doctor so he may refer you to an Orthopedist as soon as possible. In your case a "shin splints" must be ruled out, this refers to pain along or just behind the shinbone (tibia). Medically known as medial tibial stress syndrome, shin splints occur during physical activity and result from too much force being placed on your shinbone and connective tissues that attach your muscles to the bone. Shin splints are common in runners and in those who participate in activities with sudden stops and starts, such as basketball, soccer or tennis. Shin splints are usually diagnosed based on your medical history and a physical exam. In some cases, an X-ray or other imaging studies can help identify other possible causes for your pain, such as a stress fracture (tiny cracks in a bone often caused by overuse). In most cases the treatment is conservative: rest, avoid activities that cause pain, swelling or discomfort, if your shin pain causes you to limp, consider using crutches until you can walk normally without pain. Apply ice packs to the affected shin for 15 to 20 minutes at a time, four to eight times a day for several days. To protect your skin, wrap the ice packs in a thin towel. Elevate the affected shin above the level of your heart, especially at night. It may also help to compress the area with an elastic bandage or compression sleeve. Loosen the wrap if the pain increases, the area becomes numb or swelling occurs below the wrapped area. You may take anti inflammatory medication (“Motrin”, “Aleve”) to control pain and inflammation.

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