Wrong diagnosis - calf tear

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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?



Ron

 

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.

 

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.