The shin bone is called the tibia in medical terminology. It is a long tubular bone of the lower leg. A shin contusion, or shin bruise, happens when you have a small injury on the surface of a bone. Another bone of the lower leg is the fibula, which is much narrower than the shin bone and lies laterally outside the tibia. At the proximal end of the tibia, i.e., at the end of the bone further towards the middle of the body, there is a so-called tibia plateau (lat. tibia plateau). This is the base for essential structures of the knee joint, namely the cruciate ligaments and the menisci. Also, the shinbone is connected to the thigh bone via the plateau, so that it is involved in the formation of the knee joint. Since it is a tubular bone, the shin bone has a long shaft. This is the prominent site of the tibia bruise and also the origin and attachment points for muscles of the lower extremity. The distal part of the tibia, i.e., the part of the bone further away from the center of the body, is involved in the formation of the upper ankle joint.
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A contusion is a lesion that is accompanied by swelling and bruising due to external force. In medical jargon, the bruise is also called contusion (lat. contusion).
The contusion can affect various organs so that a distinction is made between muscle, joint, or bone contusion. In our case of a tibial contusion, it is, of course, a bone contusion. The various bruises have in common that they are accompanied by edema formation due to lymphatic fluid and blood leaking from the smallest blood vessels (capillaries).
Predisposed sites for a bone contusion are generally sites where bony structures are relatively superficial. Therefore, the tibia is a typical site of manifestation of a tibial contusion. As everyone knows from personal experience, there is only a thin layer of skin over the shin bone. The easily palpable part of the tibia lying under the skin is called the “Margo anterior,” a front edge of the bone. This is a bone point that separates the middle and lateral bone surfaces of the tibia. The shaft has a total of 3 bone sides: a middle, a lateral, and a posterior side. The area between the edge of the bone and the skin is so thin because there is hardly any fat or muscle tissue in this area, which could act as a buffer or kind of shock absorber to protect against shin bruising. The fact that the thin skin is very well innervated also makes a shin bruise a harrowing event.
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Causes of a shin bruise
Reasons for a shinbone contusion are very catchy. One usually gets a bruise on the shin bone by striking the shin bone or kicking against a rigid or stable object that cannot give way. A fall on the shin bone can also cause a bruise. Therefore such an injury can occur in everyday life as well as during sports activities. Two-match team sports such as football or hockey are considered particularly risky sports with regard to shin bruises. As mentioned above, the shin bone is poorly protected and very susceptible to bruising due to the lack of cushioning from fat or muscle tissue.
Symptoms of a shin bruise
The classic symptoms of a shin bruise are pain, swelling, a bruise, and a particular restriction of movement.
Since the thin skin above the shin is very well innervated, there is a high sensitivity to pain. A shinbone contusion, therefore, causes an immediate, sharp pain. The intensity of the pain can be intensified by pressure or load or movement. Fortunately, the initially extreme pain subsides relatively quickly.
In time, the affected tibial area will also swell. The reason for this is the fact that the bruising causes the tissue types involved to compress against each other. The softer tissue, i.e., the skin, is pressed so hard against the hard bone that the bruise causes blood and lymph to leak into the surrounding tissue, as explained above. The spread of the two fluids can then be visually perceived as a swelling or dent in the shin bone. The dent is so apparent because there is no concealing muscle or fat layer.
In addition to this, a hematoma, i.e., a bruise, forms between the skin and bones because of the blood that has leaked out. The typical discoloration remains a little longer; usually, several days, so that the shin bone still shimmers bluish to purple at the bruise site after the swelling has subsided. In some cases, a shin bruise can also cause slight restrictions in movement. However, this symptom is more common in joint or muscle contusions.
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Diagnostics of a shin bruise
In an ultrasound examination, muscle and tendon injuries can be easily detected.
In most cases, the shinbone contusion is a diagnosis of gaze. The typical symptoms like swelling and bruising are relatively easy to define. It is then essential for the doctor to conduct a detailed anamnesis interview to get an overview of the course of the accident. This enables the doctor to exclude or even consider possible differential diagnoses. The typical character of the pain – first very severe, then soon fading away – should also be asked. Then the physical examination is scheduled, which includes palpation of the affected tibia. During this examination, it is essential to check whether there are any indications of a fracture of the tibia. Fracture signs that would be indicative are the formation of steps, abnormal mobility, and crepitations. The exclusion of an involved bone fracture is essential, as this is the most important differential diagnosis of tibial contusion.
If there is uncertainty about symptoms, an X-ray examination to show the bony structures can be revealing. If necessary, an ultrasound examination can also be performed. However, ultrasound is more critical in the case of muscle and joint contusions, as this is more likely to damage tendons and ligaments, which can be visualized by ultrasound.
Therapy of a bone bruise
If a bone fracture is present, surgery may be required.
The tibial contusion is a harmless and relatively uncomplicated injury. Therefore, it is usually not necessary to consult a doctor. The shin bruise can be treated very well by the patient him/herself using the PECH rule. The primary goals of this immediate measure are pain relief and reduction of swelling.
“P” stands for pause and means that the shin bone should be immobilized immediately. If it is subjected to further strain, the effort will result in increased blood circulation. The stimulation of blood circulation would then increase the risk of vascular lesions and the persistence of symptoms or aggravation. In general, the tibia should not be stressed for at least two days. However, one should not pause for too long; after 14 days at the latest, the affected region of the shin should usually be loaded again.
In addition to pausing, the cooling of the bruise is an essential goal (“E” for ice). You should not bring the ice into direct contact with the skin, but place a cloth or similar between the ice source and the skin.
Furthermore, the area must be compressed (“C” for compression) to reduce the swelling. Compression by applying a tight bandage can be combined with cooling by wrapping an ice pack between the bandage loops.
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Finally, the leg should be elevated (“H” for elevation). This promotes, among other things, the evacuation of lymph, which has reached the surrounding tissue through the bruising. All aspects of the PECH rule must be initiated promptly. Otherwise, they would be unhelpful and ineffective in the treatment of a shin bruise. Rapid action is essential to reduce the extent of the swelling. With regard to the lymph fluid, some doctors also recommend lymph drainage. There is, however, agreement that no heat therapy or blood circulation-promoting ointments should be used.
For medicinal therapy, there is the possibility of applying pain-relieving ointments or sports gel to cool the bruised area. The very well-known and proven phytopharmaceutical from the field of naturopathy, the so-called “comfrey” (Symphytum officinale), is also frequently used. In addition to the bruise, sprains or strains are considered to be indications for the application of comfrey ointment. Its effects include local irritation reduction, promotion of wound healing, and the property of having anti-inflammatory (antiphlogistic) and decongestant effects.
As long as there is no suspicion of a fracture, conservative treatment is sufficient. However, if there are persistent symptoms or if the suspicion of a tibia fracture hardens, an invasive procedure may have to follow. This includes the surgical procedure but also the puncture of the swelling or bruise. In the case of a severe effusion, this must be opened and cleared out and then treated with a drainage system to remove the remaining secretion.
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