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Young Man With Painful Swelling on the Medial Shin

Young Man With Painful Swelling on the Medial Shin

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A 19-year-old athlete complains of
pain and swelling of the anterior
pretibial area of his right lower leg. He
hopes to win a football or track scholarship
to college and is concerned
because his symptoms are impairing
his performance.

History. The symptoms started
about 6 months earlier when he experienced
"shin splints" during the
spring track season. He specialized
in the 100- and 200-meter dashes.
After the season ended, the pain and
swelling began to resolve; however,
these symptoms returned during
football workouts in the fall.

When he made sharp cuts on
the field or accelerated quickly,
the pain increased. He was told by
the coach that the injury was a bruise
and was advised to continue practice.
With the regular exertion of
practice and the season's games, the
symptomatic area became more
swollen. He now experiences pain
with simple weight bearing.

There is no history of redness
at or drainage from the site, joint
pain, fever, or generalized leg
edema. Although he plays running back and is tackled
frequently, he has had no penetrating or other leg injury
except for the usual bruises.

Examination. The patient is muscular and well built.
Pulse rate is 60 beats per minute; respiration rate, 18
breaths per minute; blood pressure, 110/80 mm Hg. The
only abnormalities noted are a tender 3 X 4-cm slightly
rubbery soft tissue mass overlying the lateral aspect of
the middle of the right tibial shaft, and a discrete bony
nodule or prominence on the anterolateral tibial surface.
The patient rates the pain as 6 on a scale of 1 to 10. There
is no fluctuation, erythema, or drainage. Knee and ankle
joints are normal. No inguinal adenopathy is noted, and
the neurovascular status of both lower legs is normal for
his age and level of conditioning.

Anteroposterior and lateral plain radiographic views
of the tibia are ordered.

What do the films show—and to what diagnosis do
these findings point in light of the patient's history?

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