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Accurate Diagnosis of Shin Pain Needed to Direct Treatment

Shin splints, stress fractures, and compartment syndrome are the three most common causes of lower leg or shin pain in athletes. Runners are especially prone to these types of overuse injuries.

A correct diagnosis is needed to ensure proper treatment. But symptoms are often the same or similar making an accurate diagnosis difficult. In this article, the causes of shin pain, their diagnosis, and treatment are reviewed.

The physician must rely on the history and physical exam. Was there an injury? What kind of specific trauma occurred? What are the symptoms? Where is the pain located? The exam includes evaluation of motion, gait (walking pattern), tenderness, flexibility, and strength.

Some tests are as simple as squeezing the soft tissues or single-leg toes raises, which stress the muscles and tendons. X-rays may be needed to confirm stress reactions or fractures. But X-rays only show fractures half the time when they are really there. So when diagnosing stress fractures, a bone scan is the current gold standard.

For a compartment syndrome, the exam is followed by measuring the compartment pressures. A compartment syndrome is a dangerous increase in pressure of the areas of soft tissue inside the lower leg. Measures are taken before and after exercise. Muscle volume changes with activity. If the connective tissue separating the compartments can't respond to muscle volume expansion, then compartment syndrome may occur.

Treatment for shin pain depends on the underlying cause of the symptoms. Often, rest and inactivity are advised for shin splints and stress fractures. Establishing a diagnosis of compartment syndrome is important because surgery is often needed to prevent serious complications from developing.

References: W. Bradley Strauch, MD, and W. Paul Slomiany, MD. Evaluating Shin Pain in Active Patients. In The Journal of Musculoskeletal Medicine. March 2008. Vol. 25. No. 3. Pp. 138-148.

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