Bad To The Bone: A Piercing Case Of Anterior Shin Pain - Page #1

Author: Giorgio Negron, MD
Co Author #1: Giorgio A. Negron, M.D.
Co Author #2: Sara N. Raiser, M.D.
Senior Editor: Carolyn Landsberg, MD
Editor: Bari Madureira, DO, MPH

Patient Presentation:
A 59-year-old female with osteoporosis, on hormone replacement therapy, and hypothyroidism presented to clinic with a one-week history of right shin pain.

The patient reports that she first noticed the shin pain when she brushed it with her hand while weeding in her garden. Pain is described as sharp and nerve-like. Pain is worse when weight bearing on the right lower extremity and especially when climbing stairs or out-toeing when walking. She also notes pain when stretching her calf muscles. She reports feeling a knot over the mid-shin at the area of tenderness. Patient has a personal history of osteoporosis with last DXA scan 7 years ago and a previous thoracic vertebral compression fracture. She was on teriparatide for osteoporosis therapy about 10 years ago. She denies any numbness, tingling, focal weakness, or back pain. She does have anteromedial knee pain. Patient previously played competitive volleyball when she was younger and denies any family history of neurological or rheumatological disorders.

Physical Exam:
Musculoskeletal/Neurological Exam:
Inspection: No gross swelling, erythema, ecchymoses, or wounds. Scattered varicose veins noted at ankles bilaterally.
Palpation: Tenderness to palpation at intersection of middle and distal thirds of the right medial tibia with palpable nodule. No tenderness to palpation of left.
Range of Motion: Full, painless with bilateral knee flexion and extension and ankle dorsiflexion and plantarflexion.
Strength: Full with bilateral knee flexion and extension and ankle dorsiflexion and plantarflexion
Sensation: Intact throughout bilateral lower extremities.
Special Tests: Pain with tibial percussion on right. Pain with single leg stance on right. Declined hop test on right due to pain apprehension.

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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