Transient Leg Cramping — Swimming

Abstract

HISTORY: 18 year old male presented with pain in his bilateral feet, ankles, and lower legs that began 8 months ago after playing basketball. He dove for the basketball and landed on his right hip and his teammate landed on top of him. The following day, he was playing in a basketball game and he landed on his right hip again after getting a rebound. Ever since the second fall, he has had pain in his BLE that starts in his feet (dorsal and plantar aspects) and radiates proximally to his posterior ankles and then to his calves. He states that the pain typically stops at the mid-calf region. The pain consistently begins 5 minutes into jogging and running or 15 minutes after playing basketball. He describes the sensation as burning and cramping. He states that he also has low back pain but this pain does not radiate down his legs. He denies fevers, chills, bowel and bladder issues, night pain, and saddle anesthesia. PHYSICAL EXAMINATION OF BILATERAL LOWER EXTREMITIES:No erythema, edema, or ecchymosis. Non-tender to palpation over bilateral calves, medial and lateral malleoli, anterior ankle, fibular head, and ankle syndesmosis. Full ROM in the BLE. Hip Flexion 5/5, Knee Flexion 5/5, Knee Extension 5/5, Dorsiflexion 5/5, EHL 5/5, Plantarflexion 5/5. Negative Straight Leg Raise test bilaterally, Negative FABER and FADIR tests, Negative Syndesmosis Squeeze and Thompson Tests DIFFERENTIAL DIAGNOSIS:1. Lumbar Radiculopathy 2. Chronic Exertional Compartment Syndrome 3. Peripheral Neuropathy TEST AND RESULTS: Bilateral Hip X-Rays were unremarkable. MRI Lumbar Spine demonstrated Spondylosis at L5-S1 but no evidence of nerve root impingement, neuroforaminal stenosis, or spinal canal stenosis. BLE compartment testing demonstrated compartment pressure of at least 25 mm Hg at baseline in all 4 compartments bilaterally and an increased in compartment pressure to over 30 mmHg 1 minute after physical activity in all 4 compartments bilaterally except for the Left Deep Posterior Compartment. FINAL WORKING DIAGNOSIS: Chronic Exertional Compartment Syndrome TREATMENT AND OUTCOMES: Patient has been referred to an Orthopedic Surgeon to discuss possible surgical interventions including fasciotomy. He is also considering non-operative interventions which consist of working with a physical therapist to revise his running mechanics.