Thursday 22 March 2018

Dear Dr Nina: Will the lump on my shin ever go away?

Photo posed
Photo posed

Nina Burns

I play camogie and a few months back was hit in the leg with a stick. It wasn’t particularly sore at the time but it did leave quite a bruise on the front of my left shin bone. However, now a number of months on from the incident, there is a permanent lump in the spot where I was hit. It is tender to the touch and it feels like loose cartilage under the skin or something. Could I have fractured the bone in some way? I’m worried it will never heal

Dr Nina replies: It is always worth having a swelling that is sticking around checked out by your doctor. Pain below the knee in the front of the leg is relatively common, especially in those who play sports that involve running, jumping and twisting.

A direct injury to the bone could cause some bone bruising which although not a fracture can cause pain, tenderness and swelling at the site. It is extremely unlikely that you have a fracture of your tibia as this bone is one of the stabilising ones of the leg and as such a fracture would make normal walking impossible. It is more likely that you have a strain injury.

Overuse of the quadriceps muscle at the front of the thigh puts pressure on the ligaments of the kneecap, which ultimately pulls on the top of the larger bone of the lower leg (the tibia). The point where the ligament attaches becomes inflamed and sore, leading to pain in this area.

The patella (or kneecap) is a disc of bone that protects the knee joint and helps the thigh muscles move the knee. The patella is one of three bones in the knee. The others are the tibia (lower leg) and femur (thigh).

The quadriceps tendon connects the upper leg through the knee to the lower leg. If the patella sits in an unbalanced way, it can slip out of the joint, putting pressure on the femur and structures of the knee. All of these can cause pain.

Tight thigh muscles can also lead to knee and kneecap pain. Knee pain is most common during periods of rapid growth and front-of-knee pain is more common in girls than boys.

Causes include joint inflammation, pain radiating from the hip, a misaligned patella or ligament bone, or tendon damage. Recurrent dislocation of the patella may be due to loose ligaments surrounding the joint. This is more common in young girls.

When the patella is in place, it can glide smoothly over the surface of the femur. Other symptoms may include pain that is worse with exercise but goes with rest, limping after exercise, and tightness of the muscles around the knee.

Rest is the best treatment. Taking a break from vigorous sports will allow the inflammation and soreness to settle down. Simple over the counter painkillers such as paracetamol and ibuprofen may give some relief. Applying heat or ice may also help. Wearing gel pads over the bump may protect it from painful bangs. A physiotherapist may be able to help by easing the transition back to activity and teaching some appropriate stretching exercise for before and after activity.

Pain occurring at rest, pain that awakens one at night or pain in the thigh may be due to other conditions and a chat with your doctor is required.

An x-ray may be advised. MRIs are rarely needed. If initial tests are normal, then physiotherapy will be advised.

Physiotherapists are an excellent source of assessment and advice when it comes to muskuloskeletal injuries and pain.

It is important to note however that heeding their advice re exercise and rest is a really important part of recovery. A rest and recovery prescription can be as important a any medication prescribed.

Q. I had the flu back in early December and was in bed for a fortnight — it was a really bad dose. But I still have a lingering cough which gets worse at night. I don’t smoke, and am in good health.

Dr Nina replies: Influenza is a highly contagious virus that attacks the respiratory system and spreads rapidly from person to person. It occurs in all age groups all over the world but infections reach a peak during winter months with the peak flu season in the northern hemisphere running from October through April. We have had a particularly nasty flu season this year and lots of people have been unwell in recent months.

Flu symptoms last for about a week on average, however the tiredness felt with flu can continue for several weeks after the initial infection subsides.

Cough can be a frustrating lingering symptom.  Irritation anywhere from the throat to deep in the lungs will cause someone to cough. Coughs lasting two to three weeks are most often associated with a viral or bacterial respiratory infection. They can also last for some weeks after the initial infection has passed.

It is not always necessary to visit your doctor with a cough. However if you have fever, coloured phlegm, blood, wheeze, shortness of breath, weight loss or night sweats, or the cough lasts longer than a month, a doctor’s visit is essential.

Congestion in the sinus and airways causes dripping into the back of throat, also leading to irritation and coughing. This is often worse lying down. You can buy many treatments over the counter but always talk to your pharmacist. Older antihistamines can be very sedating and so the newer less sedating ones are preferred.

Nasal rinses may remove allergens and pollens from your nasal passages, which may help. Your doctor can prescribe you alternative antihistamines, nasal sprays and eye drops. Taking several medications together often works best.

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