Author: Nicholas Longe, DO
Co Author #1: Dr. Philip Van De Griend, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Jeffrey Feden, MD, FAMSSM

Patient Presentation:
A 22-year-old collegiate football player presented with progressively worsening and acutely severe left thigh pain associated with swelling ten days after sustaining a direct helmet impact during a football game.

History:
A 22-year-old male collegiate football player presented to the emergency department with severe left thigh pain and swelling ten days after sustaining a direct helmet impact to the anterolateral thigh during a football game. Immediately following the injury, he experienced localized pain and soreness, but he remained ambulatory and continued participation in football activities. Over the ensuing week, he noted persistent swelling and discomfort that failed to improve with conservative measures. Despite ongoing symptoms, he completed a strenuous team workout approximately two days prior to presentation.

Following the workout, the patient experienced rapidly escalating pain, increasing thigh tightness, and progressive swelling. On the day of presentation, the pain became severe and unrelenting, significantly impairing ambulation and preventing sleep. He denied any new injury, additional trauma, numbness, paresthesias, weakness, fever, chills, or other systemic symptoms. He had no significant past medical history, no prior lower extremity injuries, and was not taking anticoagulant medications.

Physical Exam:
Vital signs were within normal limits. The patient appeared uncomfortable due to pain but was alert and oriented. Examination of the left leg demonstrated marked swelling, firmness, and exquisite tenderness over the lateral aspect of the thigh. The medial aspect of thigh and lower leg compartments were soft and nontender. Distal pulses, sensation, and motor function remained intact. Hip and knee range of motion were significantly limited by pain. No erythema, skin compromise, or signs of infection were present. There was pain with both active and passive flexion of the left knee.

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