Calf Pain- Basketball

Abstract

HISTORY: A 18-year-old female athlete sustained a right calf strain during preseason basketball training. She modified activity and within ten days noted resolution of symptoms. However, on the eleventh day she noted intense tightness and swelling in right calf after a four hour car trip. Her calf was noticeably bigger and she did not seek medical attention for five days. Past medical history is significant for right ACL tear and underwent reconstruction in August 2005 and May 2008. Current medications included oral contraception only. PHYSICAL EXAMINATION: Examination 5 days after onset revealed a tense right calf with majority of firmness over right medial gastronemius. Right calf was 2cm greater than left calf. Medial aspect of the right calf had mild discoloration of skin. She noted exquisite pain with dorsiflexion and resisted bearing full weight. Normal sensation and strength was elicited and mild pedal edema noted on exam. DIFFERENTIAL DIAGNOSIS: Deep Venous Thrombosis Muscle-Tendon Rupture Hematoma Popliteal Cyst Compartment Syndrome TEST AND RESULTS: Due to the concern for deep venous thrombosis, she was sent to emergency room for evaluation. Laboratory studies and venous ultrasound with dopplers were negative, however a fluid collection was noted in medial right calf. MRI of right calf noted a large communicating popliteal cyst which dissected inferiorly within the medial head of gastrocnemius muscle. FINAL WORKING DIAGNOSIS: Popliteal Cyst TREATMENT AND OUTCOMES: 1. The cyst was drained for both comfort and to hasten recovery. Aspiration from medial calf returned 180mL of bloody fluid. A compression wrap was applied for twenty four hours, and she progressed to full activity in five days after drainage. 2. The cyst reaccumulated within a week and initial symptoms returned. We repeated the procedure aspirating 120ml of clear viscous fluid, and 1ml of kenalog was subsequently injected. Fluid was sent for further evaluation. She was shut down completely from activity and will be reassessed on a weekly basis.