Worsening Leg Pain In A Collegiate Football Player - Page #1

Author: Arsh Dhanota, MD
Co Author #1: Rahul Kapur, M.D. Assistant Program Director
Co Author #2: Brian J. Sennett, M.D. Chief of the Division of Sports Medicine

Patient Presentation:
Left lower leg pain

A 22 year old collegiate football player presents at the end of the game with pain and swelling over the lateral aspect of his left lower leg. He cannot recall at what point during the game the injury took place. He does not recall the mechanism of injury or hearing or feeling a pop. His pain initially was aggravated by cutting and not present while running in a straight line, but now his pain is constant , present at rest, and worsening in severity. He can bear weight but is favoring his right leg. He denies numbness, tingling, weakness, or instability involving his left lower extremity. Review of systems is otherwise negative.

Physical Exam:
Left Lower Extremity:

There is an obvious deformity over the lateral aspect of his left leg when compared to the right. He has fullness at the distal aspect of his left ankle and lateral compartment.

Sensation in his left foot is intact

Dorsalis Pedis and Posterior Tibial Artery pulses are 2+

He has full range of motion of his left ankle but movement of his ankle illicits pain over the lateral aspect of his lower leg.
Forced ankle inversion and stretch on the lateral tendons illicits the most pain.

He has 3/5 strength with eversion of his ankle
He has 5/5 strength with plantarflexion and doriflexion of his ankle

There is a palpable fullness with mild tenderness at the distal aspect of his lateral compartment which is greater than the proximal aspect.
The distal fibula, tibia, ATFL, CFL, syndesmosis and achilles tendon are non-tender to palpation.

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