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Long Distance Runner With Asymmetric Leg Pain And Weakness - Page #1
 

Author: Julia Rawlings, MD
Senior Editor: Christian Fulmer, DO
Editor: Christian Fulmer, DO

Patient Presentation:
A 37-year-old female recreational runner presented with 3 months of squeezing pain and fatigue of the right leg with exertion. The symptoms started two weeks after the patient began training for her 11th marathon. The symptoms worsened with elevated heart rate and lasted up to two days after intense activity. Biking caused worse symptoms than running. She would first feel pain and fatigue in the medial thigh, which would progress to the entire upper leg and calf with numbness of the medial foot. There was no color change or temperature change to the leg.

History:
Six months after the initial presentation to sports medicine, she was referred to vascular surgery for concerns of external iliac artery endofibrosis (EIAE). Ankle-brachial index testing with exercise and arterial ultrasound of the bilateral lower extremities was ordered. During the ultrasound, there was an incidental finding of an abnormality in the infrarenal aorta. The patient recalled that two weeks prior to this test, she had acute onsest of abdominal pain following a soccer game. There was no notable trauma during the game. A repeat CT angiogram of the abdomen and pelvis was ordered.

Physical Exam:
Vital signs found a blood pressure of 113/72, heart rate of 78, temperature of 37.7. The patient is awake, alert, and in no distress. The cardiovascular exam was normal, including symmetric pulses of the femoral, popliteal, and dorsalis pedis pulses. Abdomen was soft, non-distended, and non-tender. Musculoskeletal exam found the legs were symmetric with normal size and temperature. There was no tenderness to palpation of the spine. She had normal range of motion in the lower extremities with 5/5 strength in all muscle groups. The neurologic exam was completely normal, including negative straight leg raise, negative slump test, and 2+ patella tendon and Achilles reflexes.

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