Leg Injury - Soccer

Abstract

0625 Part 1 HISTORY: A 17 year old soccer player entering his senior year of high school injured his anterior right thigh after hitting another player's hip while jumping up to head the ball. He suffered a minor bruise to his thigh, but continued to play the game and played one more game that day. The next morning his thigh was still sore and he described it as a ‘charlie horse’. To alleviate the soreness he filled a bathtub with ice water and submersed both legs up to his waist in the tub for 15 minutes. He tried to play in the tournament that day, but was unable to because of the pain. He then drove six hours home with his parents. While in the car, his leg pain got progressively worse. Five hours into the trip his thigh became very tight and the pain was described as 10/10 when sitting still. His father thus brought him straight to the emergency room. PHYSICAL EXAMINATION: Examination in the emergency room revealed a very firm thigh, extremely tender to palpation. He denied having any numbness or tingling to his lower leg, but was unable to extend his knee due to pain. With passive flexion of his knee, his thigh pain was exacerbated. He had equal patellar and achilles reflexes bilaterally. He also had palpable dorsalis pedal and posterior tibialis pulses bilaterally. His anterior tibialis, EHL and gastrocnemius/solius complex strength were 5/5. His sensation to his entire thigh and leg was intact. Part 2 DIFFERENTIAL DIAGNOSIS: Quadriceps tear Quadriceps hematoma Quadriceps strain Quadriceps compartment syndrome Femur fracture TEST AND RESULTS: Femur xray: No signs of femur fracture, no evidence of knee effusion Arterial line compartment pressure measurements of quadriceps muscle: The anterior compartment pressure was 64 mm/Hg. FINAL/WORKING DIAGNOSIS Quadriceps compartment syndrome TREATMENT AND OUTCOMES: Patient was taken to the Operating room for a fasciotomy of his right thigh. Fasciotomies of the rectus femoris fascia and vastus lateralis fascia were performed with significant muscle protrusion after the fasciotomies. Minimal hematoma was seen. The patient's hemoglobin dropped from 13.2 to 8.6 over two days. An MRI was done which showed a hematoma in the vastus intermedialis. The patient was taken back to the operating room to have the hematoma evacuated. The skin incision was closed four days later after thigh swelling had subsided with no further complications. Physical therapy started post operative day 21 (seven days after sutures were removed) and continued for four weeks. The patient returned to sports eight weeks post injury at full strength with painless full range of motion.