Insidious Bilateral Calf Pain In A Runner

Abstract

HISTORY: 28 year old female with bilateral calf pain related to exercise/activity. Chronic for several years with recent increas in intensity and severity. Usual exercise routine consisted of biking, jogging or elliptical, weight training. Symptoms: diffuse, dull, achy pain with hardening of calves occurring after exercising, most notable in the evenings after exercises, and had extended for a period of 2-3 weeks. Lingering calf pain woke patient up at night on nights after she has been active and only affected her calves, was not related to swelling of the muscles, red inflamed joints, or any rashes. She denied any actual cramping of the muscle or any dark urine associated with these episodes. No specific weaknes. No fixed numbness or tingling, changes in her voice, double vision, ptosis, or shortness of breath with activities. No recent changes in her medications. No alleviating factor other than rest. Past Medical History: Migraines, hypothyroidism, asthma, iron deficiency anemia, depression, anxiety, gastritis, and IBS Past Surgical History: Muscle biopsy in 2013 Medications: Sumatriptan Butalbital-acetaminophen-caffeine Synthroid Montelukast Clonazepam Prilosec Ferrous gluconate Topiramate Desvenlafaxine Fluticasone Eszopiclone Albuterol Allergies, Social, Family hx noncontributory PHYSICAL EXAMINATION: Physical Exam: Normal vitals, no distress. Heent: Normal. CVS: Normal Extremities: Normal pulses and sesation MSK exam of BL lower extremities and spine is completely normal. DIFFERENTIAL DIAGNOSIS: Chronic exertional compartment syndrome PVD Popliteal artery entrapment Myofascial pain Myositis Lumbar radiculopathy Inflammatory myopathy Deep venous reflux TEST AND RESULTS: EMG negative X-rays of BL Lower extremities and spine: negative MRI BL knee, femur, tib/fib : negative Muscle biopsy nonspecific CPT2 negative Basic chemistry negative Thyroid studies negative ANA: positive low titer Vascular ABI: negative Exertional compartment test: borderline pressure elevations in lateral compartment MRA Bilateral lower extremities: Negative Catheter Angiogram BL LE: + BL popliteal artery entrapment FINAL WORKING DIAGNOSIS: Bilateral popliteal artery entrapment TREATMENT AND OUTCOMES: Bilateral surgical release of accessory band of medial gastrocnemius with initial good results