Shin in­jury painful for too long

Prince Albert Daily Herald - - LETTERS TO THE EDITOR - Keith Roach

DEAR DR. ROACH: I in­jured my left shin by im­pact two years and one month ago, and to my as­ton­ish­ment, it still hurts on a di­min­ished but reg­u­lar ba­sis.

I had an X-ray, vein test, nerve test and, fi­nally, an MRI, which showed “some swelling.” One doctor told me that it could hurt for the rest of my life! I am in my 60s, but he said age was not a fac­tor. Is this re­ally true? I read that a bone con­tu­sion is ex­tremely painful and can take from two weeks to two years to heal; the article did not spec­ify why there is such a large time range, and I as­sume age, sever­ity of in­jury and con­di­tion of bone are is­sues.

I suf­fered a tibia and fibula break one year be­fore this in­ci­dent, but I was walk­ing nor­mally and had very lit­tle dis­com­fort from that. This pain is right in the same spot all the time -- ex­actly where my leg was hit.

My sur­geon from the fib/tib said that my bones were 100 per­cent healed by the time of this new in­jury. Please ad­vise as to whether my shin re­ally could hurt for the rest of my life. -- C.M.

AN­SWER: Bone con­tu­sions are very painful. The nerve sup­ply to the lin­ing of the bone is ro­bust, and those nerves don’t nor­mally send pain sig­nals. When they do, the pain can be ex­quis­ite. How­ever, two years is too long for this to be go­ing on.

The tibia (shin bone) is very su­per­fi­cial. In a bad trauma to the shin, bac­te­ria can en­ter through the skin and some­times can in­fect the tibia it­self. This is called os­teomyeli­tis. How­ever, the MRI scan is very sen­si­tive to this pos­si­bil­ity, and most peo­ple would have signs of in­fec­tion, in­clud­ing fever. There also are frac­tures of the tibia that ini­tially don’t show on X-ray; again, the MRI is a sen­si­tive test. But, even an MRI isn’t per­fect, and it may be worth­while to re­peat it.

How­ever, I think the most likely con­di­tion is nerve dam­age. Specif­i­cally, I am wor­ried that you have a form of com­plex re­gional pain syn­drome. This oc­curs af­ter a trauma and causes per­sis­tent pain, usu­ally with some changes to the skin or mus­cle. The real key to the di­ag­no­sis would be ab­nor­mal pain sen­sa­tion around the area, with light touch caus­ing pain (this is called al­lo­dy­nia) or an ex­ag­ger­ated re­sponse to pain, such as a pin­prick (this is called hy­per­al­ge­sia). Nerve test­ing and imag­ing some­times are ab­nor­mal in this con­di­tion, but some­times not. An expert in pain man­age­ment is the best per­son to see. Hurt­ing for the rest of your life is not a good op­tion.

DEAR DR. ROACH: I’m an oc­to­ge­nar­ian with prostate is­sues. My doctor sent me some in­for­ma­tion about the prostate lift pro­ce­dure. Can you tell me about it? -- R.T.

AN­SWER: The prostate lift pro­ce­dure is con­sid­ered a min­i­mally in­va­sive sur­gi­cal pro­ce­dure for men with symp­toms of an en­larged prostate. It has been shown to im­prove symp­toms and qual­ity of life in men with mod­er­ate to se­vere symp­toms of non­cancer­ous prostate en­large­ment. It seems to be bet­ter tol­er­ated than tra­di­tional prostate surgery, with a sim­i­lar im­prove­ment in symp­toms. It seems like a good op­tion for men with prostate symp­toms in whom med­i­ca­tion alone doesn’t pro­vide ad­e­quate re­lief.

The book­let on the prostate gland dis­cusses en­large­ment and cancer. Read­ers can ob­tain a copy by writ­ing:

Dr. Roach

Book No. 1001

628 Vir­ginia Dr.

Or­lando, FL 32803

En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please allow four weeks for de­liv­ery.

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