Unilateral Lower Leg Weakness In A High School Football Player - Page #1

Author: Roy Kim, DO
Co Author #1: Keith Feder, MD
Co Author #2: William Hohl, MD
Senior Editor: David Siebert, MD
Editor: Mandeep Ghuman, MD, FAMSSM

Patient Presentation:
The patient presented with right leg pain and a foot drop.

A 16-year-old healthy male presented with right lower leg weakness. During a football practice, he developed pain and tightness along his right calf muscles that progressed to severe leg pain. He denied trauma to his leg. His parents took him to an urgent care that evening where x-rays did not reveal any significant findings. He was diagnosed with muscle spasms, prescribed a benzodiazepine, and told to follow up if symptoms worsened. His symptoms of numbness and pain worsened, and he sought further evaluation by his primary physician 1 day post injury. He was prescribed anti-inflammatory medications and muscle relaxers. Four days post injury, he developed an inability to lift his right foot. At this point, he was recommended by his athletic trainer to see an orthopedist, who ordered an MRI of the right lower leg. The MRI revealed a mass compressing the common peroneal nerve of the right leg. A chiropractor affiliated with the football team recommended he be evaluated in a Sports Medicine clinic. He did so 12 days post injury.

Physical Exam:
At presentation to the Sports Medicine clinic, his physical exam was notable for normal spine range of motion and soft leg compartments. Right tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus longus strength testing were 0/5. Right plantarflexion, foot inversion, flexor hallucis longus, hip extension, hip flexion, hip adduction, hip abduction, knee extension, and knee flexion strength testing were 5/5. Sensation testing revealed right leg dense numbness in the distribution of the superficial and deep peroneal nerves. Straight leg raise testing was negative bilaterally. Achilles and patellar deep tendon reflexes were 1+ bilaterally. Peripheral pulses were strong. A left leg exam was normal.

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