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Middle aged relatively fit fellow limped in last week with right calf pain.
During tennis that morning, went for the ball and felt/heard 'pop'.
Medial aspect of gastroc belly was tender. Palpated achilles tendon...felt OK. Did not do squeeze test. Dorsi-flexion lunge mildly restricted. Provisional diagnosis was grade 1+ to 2- medial gastroc tear. Treatment consisted of a few unloading strategies/techniques for the medial calf.
6 days later (today) limped in again unchanged subjectively and objectively. Slight increase in swelling calf. No deep pin-point pain c/o. No colour changes c/o. No hot or cold sensation c/o. Tight pressure feel (examiner). Tenderness about medial aspect of medial gastroc similar to initial consultation. Techniques today focussed on swelling.
Sent for ultrasound investigation to exclude blood pooling/DVT/vascular disruption and include/confirm muscular pathology.
Ultrasound investigation after consultation 2 highlighted a blood clot. Went straight to Doc for an 'injection' to address clot.
Question is what tests/questions would have more accurately pointed to a 'clot' on day 1?
Question is what tests/questions would have more accurately pointed to a 'clot' on day 1?
I don't think there are any, except for a history of risk factors....but why would you check for them due to the "pop" while playing tennis. The other thing may be the nature of any skin discolouration and the pain from clot tends to be more diffuse than a tear .... but a tear can also be somewhat diffuse. Also from what I understand the 'warmth' from clot is also more diffuse over the whole calf whereas the 'warmth' from the tear is more localised.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Middle aged relatively fit fellow limped in last week with right calf pain.
During tennis that morning, went for the ball and felt/heard 'pop'.
Medial aspect of gastroc belly was tender. Palpated achilles tendon...felt OK. Did not do squeeze test. Dorsi-flexion lunge mildly restricted. Provisional diagnosis was grade 1+ to 2- medial gastroc tear. Treatment consisted of a few unloading strategies/techniques for the medial calf.
6 days later (today) limped in again unchanged subjectively and objectively. Slight increase in swelling calf. No deep pin-point pain c/o. No colour changes c/o. No hot or cold sensation c/o. Tight pressure feel (examiner). Tenderness about medial aspect of medial gastroc similar to initial consultation. Techniques today focussed on swelling.
Sent for ultrasound investigation to exclude blood pooling/DVT/vascular disruption and include/confirm muscular pathology.
Ultrasound investigation after consultation 2 highlighted a blood clot. Went straight to Doc for an 'injection' to address clot.
Question is what tests/questions would have more accurately pointed to a 'clot' on day 1?
Ron
Ron:
My clinical guess is that there was a plantaris rupture on day 1 with no blood clot then somewhere in the next 5 days he developed the superficial or deep vein thrombosus that was picked up on US. I don't know if anyone could have done any better. You did your job well.
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Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Wrong diagnosis - calf tear
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