Acute Atraumatic Leg Pain In A 34 Year-old Female - Page #1

Author: Talha Khan, MD
Co Author #1: Talha Khan, MD
Co Author #2: Sheila Taylor, DO
Senior Editor: Carolyn Landsberg, MD
Editor: Emily Miller, MD

Patient Presentation:
Patient presented to the office complaining of sharp right knee and calf pain that started acutely two weeks ago.

Symptoms started while at work (medical assistant) however she denied any trauma, recent injury, obvious change in activity or other precipitating events. Her pain was localized over the lateral knee and calf. Pain worsened with activity and improved with rest. Symptoms improved mildly with ice and over the counter non-steroidal anti-inflammatory medications. She denied swelling, bruising, erythema, warmth, fevers or chills.
She has a history of hypertension and smokes about 1/2 a pack of cigarettes per day. No personal or family history of any connective tissue or rheumatologic conditions.

Physical Exam:
BMI 29.5
General: No acute distress.
Skin: No rashes on exposed surfaces.
Neurologic: Alert and oriented times three, no focal deficits. Sensation grossly intact.
Extremities: warm, no edema.
Gait: Antalgic.
Right knee: No scars, ecchymosis, or erythema. No effusion, or crepitus. Focal tenderness to palpation over lateral joint line, Gerdy's tubercle. Significant pain out of proportion on palpation of fibular head, lateral calf compartment, and peroneal muscle bellies.
Range of motion limited by pain with active knee flexion 0 to 90 degrees. Unable to passively range due to guarding.
Strength: 5/5 knee flexion/extension, 5/5 ankle dorsiflexion/plantar flexion, eversion, inversion. Significant pain with ankle inversion and eversion.
Left knee: No effusion, crepitus. No tenderness to palpation. Full range of motion. Strength 5/5 knee flexion/extension, ankle dorsiflexion/plantar flexion, inversion and eversion.

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