A Case Of Lingering Calf Pain

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A Case Of Lingering Calf Pain - Page #1

Author: Aisha Bowen, MD Senior Editor: Kevin Gray, MD Editor: Yu-Tsun Cheng, MD Patient Presentation: 29 year old female with chronic bilateral posterior calf pain. History: She has a history of bilateral popliteal artery entrapment syndrome and is status-post surgical release over 10 years ago. After surgery she noted improvement in her symptoms and was able to return to play Division I soccer. She did well with minimal symptoms until the past 6 months, with her left lower extremity pain being worse than her right. Pain was described as a burning sensation present at rest and aggravated by activities such as plantarflexion of bilateral ankles. The pain radiated down her legs and was associated with numbness, mostly at night. She has not tried any medications. She also has a history of lumbar degenerative disc disease and is status-post microdiscectomy at L5-S1 over 2 years ago. She completed physical therapy over 2 years ago for both her legs and lumbar back pain with minimal change in her symptoms. Physical Exam: Her neurologic exam demonstrated a positive slump test in the left lower extremity. There was decreased pinprick sensation in the bilateral S1 dermatome with the left side being worse than the right. There was 3/5 strength with resisted dorsiflexion in the left lower extremity. Strength was otherwise 5/5 in the bilateral lower extremities. On examination of the lower extremities, there were no obvious signs of deformity besides post-surgical scarring in her bilateral popliteal fossa. There was no significant tenderness to palpation over the gastrocnemius of the right lower extremity. There was tenderness to palpation over the proximal myotendinous junction of the gastrocnemius ( medially greater than laterally) of the left lower extremity. The Achilles tendon was intact bilaterally. Prolonged plantarflexion reproduced a burning sensation in the left lower extremity. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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