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Shin injury has been painful for too long

Dear Dr. Roach • I injured my left shin by impact two years and one month ago, and to my astonishment, it still hurts on a diminished but regular basis.

I had an X-ray, vein test, nerve test and, finally, an MRI, which showed “some swelling.” One doctor told me that it could hurt for the rest of my life! I am in my 60s, but he said age was not a factor. Is this really true? I read that a bone contusion is extremely painful and can take from two weeks to two years to heal; the article did not specify why there is such a large time range, and I assume age, severity of injury and condition of bone are issues.

I suffered a tibia and fibula break one year before this incident, but I was walking normally and had very little discomfort from that. This pain is right in the same spot all the time — exactly where my leg was hit.

My surgeon from the fib/tib said that my bones were 100 percent healed by the time of this new injury. Please advise as to whether my shin really could hurt for the rest of my life. — C.M.

Answer • Bone contusions are very painful. The nerve supply to the lining of the bone is robust, and those nerves don’t normally send pain signals. When they do, the pain can be exquisite. However, two years is too long for this to be going on.

The tibia (shin bone) is very superficial. In a bad trauma to the shin, bacteria can enter through the skin and sometimes can infect the tibia itself. This is called osteomyelitis. However, the MRI scan is very sensitive to this possibility, and most people would have signs of infection, including fever. There also are fractures of the tibia that initially don’t show on X-ray; again, the MRI is a sensitive test. But, even an MRI isn’t perfect, and it may be worthwhile to repeat it.

However, I think the most likely condition is nerve damage. Specifically, I am worried that you have a form of complex regional pain syndrome. This occurs after a trauma and causes persistent pain, usually with some changes to the skin or muscle. The real key to the diagnosis would be abnormal pain sensation around the area, with light touch causing pain (this is called allodynia) or an exaggerated response to pain, such as a pinprick (this is called hyperalgesia). Nerve testing and imaging sometimes are abnormal in this condition, but sometimes not. An expert in pain management is the best person to see. Hurting for the rest of your life is not a good option.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Drive, Orlando, Fla. 32803. Health newsletters may be ordered from rbmamall.com.

Article source: http://www.stltoday.com/lifestyles/health-med-fit/health/to-your-good-health/shin-injury-has-been-painful-for-too-long/article_b7a8b87e-f98f-5f54-99ad-e8505becde81.html

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