Author: Geoffrey Hogan, MD
Co Author #1: Michelle Kirk, MD
Co Author #2: Jason Mogonye, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Kyle Yost, DO

Patient Presentation:
20 year old male American football player presented to the training room after a game with significant left thigh pain and weakness after being kneed in the thigh during the game.

History:
Patient is a 20 year-old male with no significant past medical history. He was kneed in his left thigh during a football game, causing a contusion, and ultimately, he could not continue in the game due to worsening pain. Following the game, ultrasound confirmed a hematoma in his left quadriceps muscle, and aspiration was attempted in the training room, however minimal blood was evacuated. His thigh was wrapped in an ACE bandage, he was placed in a knee immobilizer, and he was given crutches. Additionally, he was started on indomethacin and given Tramadol for breakthrough pain. Later that evening, he started experiencing worsening pain which was refractory to the Tramadol. He also started experiencing paresthesias radiating down the extent of his left lower leg. Given these worsening symptoms, he was directed to the Emergency Department.

Physical Exam:
Initial exam post-game revealed a tender and swollen left quadriceps. He had difficulty with both active and passive flexion of his left knee, and could not bear weight on his left leg due to pain. He had full and intact sensation and pulses throughout his left leg.

Upon arrival to the ED, his vital signs were normal and he was afebrile. His left thigh was exquisitely tender to palpation and his thigh was very tense. He still had intact sensation and 2+ dorsalis pedis pulses in his left leg.

When general surgery examined him, he had a very tense lateral thigh compartment. He was unable to actively or passively move his left knee secondary to pain. He had no signs of joint instability, and had 4/5 strength with plantar and dorsiflexion. He had paresthesias and a diminished DP signal on doppler as compared to his right side.

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