Announcement

Collapse
No announcement yet.

Injury to calf: diagnosis?

Collapse
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • Injury to calf: diagnosis?

    This may be interesting to dissect for neuro-orthopaediphiles:

    Scenario:
    New walking boots; jumped off a one foot high wall, landed on left foot.
    Instant sharp pain in left calf; unable to DF or PF, able to walk, on (L)forefoot only. Pain probably 7/10
    After 24 hours - swelling, completely colourless, mostly upper gastrocs.
    PROM, AROM still unchanged. Sensation OK, pain ISQ.
    After 36 hours - swelling ISQ. Some AROM and PROM of ankle. No bruising of any kind, mild linear tenderness both gastrocs. Pain reduced.
    After 48 hours - walking plantargrade with pain. Pain probably 3/10.
    Resolved within the next two days.

    Treatment was initiated within 24 hours (cautiously!)

    What was injured, why no colour in the tissues and what Rx might be tried?

    This might be very easy for most, but I am still interested in replies, and more so the thinking behind the replies.

    Nari

  • #2
    ISQ = ??
    Anders.
    "There is nothing so practical as a good theory." -Kurt Lewin

    Comment


    • #3
      Apologies...

      ISQ is Latin for "the same (as before)". It is a standard abbreviation in this country for medical documentation.

      Nari

      Comment


      • #4
        In Status Quo
        Ole Reidar Johansen, Musculoskeletal Physiotherapist
        "And if you gaze for long into an abyss, the abyss gazes also into you." - Nietzsche

        Comment


        • #5
          There is stuff to learn here, so I will bite.

          Mechanism of injury: how did he/she land on the left foot, e.g. any twisting movements?
          Anders.
          "There is nothing so practical as a good theory." -Kurt Lewin

          Comment


          • #6
            No twisting, as the hiking boots were new(ish) with full ankle support. The left foot landed first, almost plantargrade, toe --> heel.

            Nari

            Comment


            • #7
              Nari. Is dorsiflexion equally painful with knee flexed and extended or is it different? Also did you note anything regarding active or resisted toe flexion?
              Rod Henderson, PT, ScD, OCS
              It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

              Comment


              • #8
                Equally painful at first, and then after a day or so, plantarflexion became less so. Toe flexion? I don't know, not tested.

                Comment


                • #9
                  Originally posted by nari View Post
                  Equally painful at first, and then after a day or so, plantarflexion became less so. Toe flexion? I don't know, not tested.
                  I need to go back and review your initial post, but I assume you've ruled out Achilles tendon rupture? My last post wasn't clear, how about passive toe extension OR resisted toe flexion along with resisted and passive inv/ev. Basically, trying to identify if this is a gastrosoleus vs FHL, plantaris, post tib injury.

                  Anything significant on palpation today vs upon original presentation? Also age and gender of patient? Any other notable issues in the medical history? Previous LE injuries?
                  Last edited by HeadStrongPT; 08-03-2008, 09:54 PM.
                  Rod Henderson, PT, ScD, OCS
                  It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                  Comment


                  • #10
                    This injury was five years ago, but it intrigued me at the time.
                    No toe movement check - did not seem relevant.
                    No ruptures of anything of a CT nature evident.
                    Age: 61, female, no previous injury, nil relevant medical Hx.

                    Clue: No bruising of any kind.

                    Nari

                    Comment


                    • #11
                      This is interesting. Sensory and motor function of distal LE intact?
                      Rod Henderson, PT, ScD, OCS
                      It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                      Comment


                      • #12
                        Tension strain to tibial or sural nerve? I'm a little puzzled..
                        Anders.
                        "There is nothing so practical as a good theory." -Kurt Lewin

                        Comment


                        • #13
                          TO, what on earth makes you think it's a muscle (mesoderm) at all, let alone which one?
                          Diane
                          www.dermoneuromodulation.com
                          SensibleSolutionsPhysiotherapy
                          HumanAntiGravitySuit blog
                          Neurotonics PT Teamblog
                          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                          Canadian Physiotherapy Association Pain Science Division Facebook page
                          @PainPhysiosCan
                          WCPT PhysiotherapyPainNetwork on Facebook
                          @WCPTPTPN
                          Neuroscience and Pain Science for Manual PTs Facebook page

                          @dfjpt
                          SomaSimple on Facebook
                          @somasimple

                          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                          Comment


                          • #14
                            Rod,

                            Sensory/motor function OK

                            Anders,

                            Getting closer....

                            Nari

                            Comment


                            • #15
                              Originally posted by Diane View Post
                              TO, what on earth makes you think it's a muscle (mesoderm) at all, let alone which one?
                              Good Lord Diane...mechanism of injury + age of patient + dysfunction (walking plantargrade). Pain with PF. These are things (all taking place on earth mind you) that could be responsible for the presentation. Hear hoofbeats? Think horses not zebras. If it isn't a horse, time to consider zebras.

                              Back to you Nari and a more productive conversation. Completely resolved in two days? Sural pathology would certainly start to creep into mind after excluding a err...mesodermal tissue.
                              Rod Henderson, PT, ScD, OCS
                              It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                              Comment

                              Working...
                              X