An Atypical Presentation Of A Common Cause Of Lateral Leg Pain

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An Atypical Presentation Of A Common Cause Of Lateral Leg Pain - Page #1

Author: Nicole Katz, MD Co Author #1: G. Ross Malik, MD Co Author #2: Sarah F. Eby, MD, PhD Senior Editor: Kristine Karlson, MD, FAMSSM Editor: Liga Kreitner, MD, MPH Patient Presentation: A 28-year-old female with a past medical history of episodic low back pain and multiple right ankle sprains presented with 5 months of insidious onset right posterolateral ankle and lower leg pain. History: The severity of pain increased and progressed to include numbness, paresthesia, and subjective weakness. She denied symptoms proximal to her knee or recent back pain. Her pain was initially exacerbated with prolonged standing and supine positioning. It evolved to also include pain when seated and at rest. She was previously evaluated by 3 different clinicians with assessments including right ankle and knee X-rays and treatments of an orthotic, a cast boot, nonsteroidal anti-inflammatory drugs, and a common peroneal tendon sheath corticosteroid injection, with no significant improvement. Clinical history prompted lumbar spine imaging and an electromyogram. Physical Exam: The initial 2 exams focused on the right ankle and were notable for tenderness to palpation of the lateral ankle and lower leg, pain with dorsi- and plantar-flexion, full ankle range of motion, and no neurological deficits. The next exam 2 weeks later focused on the right knee and was notable for no swelling, effusion, tenderness, or ligamentous laxity; full painless range of motion of the right knee; and right extensor hallucis longus strength 4/5 with all other strength 5/5. The subsequent exam 1 day later included assessment of the lumbar spine and right hip which was significant for right extensor hallucis longus strength 4/5 (all other strength 5/5); intact sensation in the L2-S2 dermatomes; positive seated slump and straight leg raise tests; and negative flexion/abduction/external rotation (FABER), flexion/adduction/internal rotation (FADIR), log roll, Stinchfield, and Tinel tests at the proximal fibula. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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