This Case Will Make Your Skin Split - Page #1
 

Author: Jacob Erickson, DO
Co Author #1: Andrew R. Peterson
Editor: Margaret Gibson, MD

Patient Presentation:
A 16-year-old male wrestler had been followed in our sports medicine clinic for chronic pre-patellar bursitis, recurrent Morel-Lavallee lesions and recurrent MRSA cellulitis. He presented with a full thickness thigh laceration sustained while pivoting on his knee during a wrestling match (a remarkably trivial trauma). The wound measured 15 x 5 cm and exposed the fascia and quadriceps muscles. Case Photo #1This impressive injury, combined with his medical history, made our team suspicious for a connective tissue disorder.

History:
Past medical history:
-Anorexia nervosa (in remission)
-Recurrent bilateral Morel-Lavallee lesions
-Recurrent left knee MRSA infections and rare MRSA abscesses
-Right pre-patellar bursitis status post bursectomy
-Easy bruising
-Injury to right hand with 2 cm split of 3rd interdigital webspace with trivial trauma
-Growth hormone deficiency
-Hypogonadism
-Short stature
-Hypothyroidism
-Iron deficiency anemia

Physical Exam:
General: 16-year-old boy that appears that of a 14-year-old. He has a small frame, but has prominent musculature and is strikingly lean. He has bruises around both eyes with swollen cheeks.

Skin: 15 cm laceration oriented horizontally across his left anterior thigh. 20 stitches present.

Musculoskeletal: No effusion about the left knee. Knee flexion limited to ~20 degrees. Full extension. Strength through limited range of motion is 5/5 in knee flexion and extension.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.


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

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


Website created by the computer geek