Exertional Leg Pain In A Long-distance Athlete - Page #3
 

Lab Studies:
CMP, Vitamin D, Magnesium, TSH, CPK, & CK-MB all WNL

Other Studies:
X-Ray bilateral lower extremities: No fracture or cortical defect
MRI of bilateral lower extremities (non-exertional): No signal abnormality, no bony, fascial, or soft tissue defects.
Compartment testing #1 (at rest): Right superficial 15mm Hg, right deep 14mm Hg, left superficial 13mm Hg, left deep 14mm Hg
Compartment testing #1 (post-exertional, performed at sub-symptom threshold): Right superficial 18mm Hg, right deep 14mm Hg, Left superficial 17mm Hg, Left deep 18mm Hg
Compartment testing #2 (at rest): Right anterior 39mm Hg, right lateral 22mm Hg, right deep posterior 22mm Hg, right superficial posterior 18mm Hg; Left anterior 24mm Hg,
left lateral 12mm Hg, left deep posterior 28mm Hg, left superficial posterior 24mm Hg
Compartment testing #2 (1 minute post-exertional): Right anterior 48mm Hg, right lateral 22mm Hg, right deep posterior 39mm Hg, right superficial posterior 18mm Hg; Left anterior 29mm Hg, left lateral 19mm Hg, left deep posterior 41mm Hg, left superficial posterior 24mm Hg

Consultations:
The patient was initially sent for an exertional MRI which was pre-arranged with an MSK-radiologist. On the day of the MRI this radiologist was not working and a resting MRI of bilateral lower extremities was performed (insurance would not approve an exertional MRI thereafter).

The patient was initially sent to an orthopedic surgeon to perform exertional compartment testing (compartment testing #1). The patient was tested in only two compartments in both legs (notably excluding the patient's very tender anterior compartments) and was made to "jump up and down a few times" for exertional testing (this exertion did not elicit any symptoms from the patient).

After conservative care was attempted for a period of five months the patient was sent to an orthopedic surgeon due to relapse of his symptoms. At this time he was sent to a primary care sports medicine physician who performed accurate compartment testing on the patient (compartment testing #2).

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.


NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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Phone: 913.327.1415


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