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 7 days following his injury, he presented to Emergency Department: Right lower extremity was swollen, tense, neurovascularly intact, no pain with passive movement Venous duplex ultrasound: negative for acute DVT, but noted avascular fluid collection in the calf 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 Case Photo #1 . During that visit, he had normal pulses, strength, and sensation. 14 days following injury: Returned with worsening pain, swelling, and now numbness Physical Exam: The right calf was swollen and tender to palpation. There was pain with calf compression. 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. Pain elicited with passive great toe dorsiflexion and plantarflexion. Strength 4/5 ankle dorsiflexion, plantarflexion and great toe extension. 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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