Causes
Reasons for a shin bruise are very catchy. One usually gets a bruise on the shin bone by striking the shin bone or kicking against a rigid or solid object that cannot give way. A fall on the shin bone can also cause a bruise.
You can differentiate between shin bruises caused by external force, which are your own fault, i.e. when you hit or fall, or those caused by others, when you get a kick against the shin. Therefore such an injury can occur in everyday life as well as during sports activities. Two-match team sports such as soccer or field 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
The classic symptoms of a shin bruise are pain, swelling, a bruise and a certain 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, strong pain.
The intensity of the pain can be intensified by pressure or load or movement. Fortunately, the initially very strong 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 obvious because there is no concealing muscle or fat layer.
In addition to this, a hematoma, i.e. a bruise, forms between the skin and bone due to 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. In most cases, the shin bruise is a diagnosis of gaze. The typical symptoms such as swelling and bruising are relatively easy to define.
It is then important 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 diagnosis. The typical character of the pain – first very strong, but then soon fading away – should also be asked.
Then the physical examination is scheduled, which includes palpation of the affected tibia. It is important to check whether there are indications of a fracture of the tibia. Fracture signs that would be indicative are step formation, 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 as to whether the symptoms are actually based on a tibial contusion and not perhaps a fracture of the tibia, 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 important in the case of muscle and joint contusions, as this is more likely to damage tendons and ligaments, which can be visualized by ultrasound. 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 yourself 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 lead to increased blood circulation in the tibia. The increase in blood flow would then increase the risk of vascular lesions and persistence of the symptoms or worsening. In general, the tibia should not be stressed for at least 2 days.
However, one should not pause for too long. After 14 days at the latest, the affected region of the shin bone should be loaded normally again. In addition to pausing, cooling the bruise is an essential part of the treatment (“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.
Finally, the leg should be elevated (“H” for elevation). Among other things, this promotes 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 drug therapy, there is the possibility of applying pain-relieving ointments or sports gel for cooling the bruise. The very well-known and proven phytopharmaceutical from the field of naturopathy is also frequently used: the so-called “comfrey” (Symphytum officinale). In addition to the bruise, sprains or strains are considered 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 even treated via a drainage system to remove the remaining secretion (lymph and/or blood).
