A Convoluted Calf Strain

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A Convoluted Calf Strain - Page #1

Author: Anna Holman, MD Co Author #1: Amy Powell, MD Senior Editor: Jessalynn Adam, MD Editor: Siobhan Statuta, MD, FAMSSM Patient Presentation: 47-year-old man with a history of hereditary spherocytosis, hypertension, and coronary artery disease presented with worsening calf pain History: The patient felt a sharp pain in his right calf while playing volleyball. Over the next few days, had increased pain and swelling, worse with ambulation <br> <br>7 days following his injury, he presented to Emergency Department: <br>Right lower extremity was swollen, tense, neurovascularly intact, no pain with passive movement <br>Venous duplex ultrasound: negative for acute DVT, but noted avascular fluid collection in the calf <br> <br>10 days following injury, he presented to the outpatient sports medicine clinic with persisting calf pain greater than expected for a calf strain. A bedside ultrasound revealed a hematoma <a href="CaseStudyImages/CS1Aconvolutedcalfst-885.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> . During that visit, he had normal pulses, strength, and sensation. <br> <br>14 days following injury: Returned with worsening pain, swelling, and now numbness Physical Exam: The right calf was swollen and tender to palpation. <br>There was pain with calf compression. <br>Sensation testing revealed significantly decreased sensation over deep peroneal, superficial peroneal and tibial nerve distributions and mildly decreased sensation over saphenous and sural nerve distributions. <br>Pain elicited with passive great toe dorsiflexion and plantarflexion. <br>Strength 4/5 ankle dorsiflexion, plantarflexion and great toe extension. <br>Palpable dorsalis pedis and posterior tibial artery pulses Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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