Lower Leg Pain- Basketball

Abstract

HISTORY: 15yoM no PMH presented with severe 10/10 right lower leg pain that started progressively 6 hours ago while playing basketball. Prior to the game, patient had no symptoms. He denies any trauma to the leg during the game. The pan is localized to the anterior and lateral aspects of the right lower leg with only mild pain noted posteriorly. Patient stated similar pains over the past year during exercise but today pain is much more severe and not improving with rest. Also c/o numbness in his foot and is having difficulty lifting his foot. PHYSICAL EXAM: No obvious deformities or signs of trauma. The anterior lower leg is extremely firm and tender to palpation with painful passive ROM and weakness and pain with active ROM. Decreased sensation of 1st dorsal webspace. Palpable DP pulse. No overlying skin changes or mottling. DDx: 1. Medial tibial stress syndrome 2. Compartment syndrome 3. Tibial stress fracture 4. Acute arterial occlusion 5. Acute venous occlusion TESTS AND RESULTS: xray tib/fib normal compartment pressures: Anterior: 80, Lateral: 62, Post- 20, Deep post- 15 FINAL DIAGNOSIS: Acute on chronic exertional compartment syndrome TREATMENT AND OUTCOMES: Patient went directly to the OR for fasciotomy Outcome pending