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Chapter 49: Shin Pain in a Child

Covey J. Lazouras

Description of the Symptom

This chapter describes possible causes of shin pain in a child. Local causes are defined as occurring distal to the knee and proximal to the ankle along the anterior portion of the lower leg. Remote causes are defined as occurring outside this region.

Special Concerns

  • Sudden onset of pain after mechanical injury particularly with weight bearing and/or palpation

  • Complaint of bone pain without mechanical injury that has persisted for longer than 2 weeks

  • Muscle pain that has persisted for longer than 2 weeks

  • Pain with repetitive activities, such as running

  • Any neurological signs suggesting increased compartmental pressure (ie, paresthesia or weakness of muscles below the knee)

  • Pain, edema, and redness over soft tissue of the calf or anterior compartment

  • Any of the above with fever, nausea, malaise, or fatigue

CHAPTER PREVIEW: Conditions That May Lead to Shin Pain in a Child
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CHAPTER PREVIEW: Conditions That May Lead to Shin Pain in a Child
T Trauma
REMOTE LOCAL
COMMON
Not applicable

Bone bruise 972

Fracture of the tibia or fibula 974

Muscle contusion 974

Muscle strain/tear 975

Stress fracture of the tibia or fibula 977

Toddler's fracture of the tibia 977
UNCOMMON

Lumbar radiculopathies:

• L4 radiculopathy 971

• L5 radiculopathy 971

• S1 radiculopathy 971

Epiphyseal fractures 973

Nerve entrapments:

• Common peroneal nerve 975

• Superficial peroneal nerve 975
RARE
Not applicable Not applicable
I Inflammation
REMOTE LOCAL
COMMON
Not applicable

Aseptic

Medial tibial stress syndrome (shin splints) 974

Septic

Not applicable
UNCOMMON
Not applicable Not applicable
RARE

Aseptic

Not applicable

Septic

Osteomyelitis of the lumbar vertebra 972

Aseptic

Not applicable

Septic

Cellulitis 972

Dengue fever (break bone fever) 973

Osteomyelitis of the tibia or fibula 976
M Metabolic
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Va Vascular
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Anterior compartment syndrome 972
RARE
Not applicable Sickle cell anemia/crisis 976
De Degenerative
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Tu Tumor
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable

Malignant Primary, such as:

• Ewing's sarcoma 978

• Leukemia 978

• Osteosarcoma 979

• Rhabdomyosarcoma 979

Malignant Metastatic, such as:

• Metastatic disease 978

Benign, such as:

• Aneurysmal bone cyst 977

• Osteochondroma 978

• Osteoid osteoma 978

• Unicameral bone cyst 979
Co Congenital
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Ne Neurogenic/Psychogenic
REMOTE LOCAL
COMMON
Not applicable Idiopathic leg pain (growing pains) 974
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Common Ages at Which Shin Pain Presents in a Child
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