Shin Pain-soccer

Abstract

HISTORY: 20-year-old female soccer player with bilateral leg pain. Symptoms were present for over a year. Pain was localized over the mid portion of the tibia bilaterally. Symptoms were aggravated with running and improved with rest. Symptoms worsened during the soccer season with inability to complete runs at times. She had swelling involving the anterior portion of the lower leg, but denied any associated numbness, tingling or weakness. She reported minimal improvement with ice and treatment by the athletic training staff. PHYSICAL EXAM: On inspection her bilateral lower legs demonstrated tenderness along the posterior medial portion of the tibia. This area involved the middle 1/3 of the tibia bilaterally. Positive hop test bilaterally. Neurovascular status was symmetric and equal. Gait was nonantalgic. DIFFERENTIAL DIAGNOSIS: 1.Chronic exertional compartment syndrome 2.Medial tibial stress syndrome 3.Tibial stress fracture 4.Muscular strain 5.Nerve entrapment 6.Popliteal artery entrapment syndrome 7.Effort-induced venous thrombosis TESTS AND RESULTS: X-ray of bilateral lower legs: -No fracture or bony abnormality MRI of right tib-fib without contrast: -Diffuse soft tissue edema anterior to the interosseous membrane likely secondary to interosseous membrane injury. No fracture. Compartment Testing: - Pre-exercise: right leg 20 mmHg anterior and 19 mmHg lateral compartment; left leg 24 mmHg anterior and 18 mmHg lateral compartment -3-5 min post-exercising: right leg 20 mmHg anterior and 20 mmHg lateral compartment; left leg 48 mmHg anterior and 17 mmHg lateral compartment. MRI of right tib-fib without contrast (3 months after initial MRI): -Near complete resolution of interosseous membrane injury. FINAL/WORKING DIAGNOSIS: 1.Interosseous membrane rupture of right lower extremity secondary to exertional compartment syndrome 2.Bilateral lower leg exertional compartment syndrome TREATMENT AND OUTCOMES: 1.Failed conservative management 2.Underwent right lower extremity exertional anterior and lateral compartment release 3.Returned to athletics two months after surgery 4.Made a full recovery with no limitations for soccer