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Strange case

Discussion in 'General Issues and Discussion Forum' started by sspod2001, May 1, 2013.

  1. sspod2001

    sspod2001 Active Member

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    Hi Guys,

    I have a 56 yo female patient who presented in clinic yesterday and would like to share it with you for discussion and possible dx.

    pp: pain and discomfort in r/leg (peroneal area/lateral compartment) pain described as throbbing.
    hxpp: pt was walking and l/knee gave out november 2011 causing pt to fall, pt was given a cane and was limping. pain in r/leg developed approx 1/12 after l/knee injury. pt has had x-ray, mri, diagnostic ultrasound images, and nerve conduction tests performed on r/leg with no abnormality found. pt has had previous cmo which didn't really help. pt notes that pain is only present when siting or relaxing, no pain when walking or standing. pt explains she has worn knee high compression stockings since birth of 1st child 30 yrs ago.
    assess: point tenderness approx mid point of r/lateral compartment with sensitivity radiating proximal towards fibular head. no sensitivity distal from mid point. also pain on palpation r/fibular head
    neuro: wnl
    vasc: all pedal pulses palp, edema to b/legs with varicosities and telengeictasias, champagne bottle effect to both legs.
    derm: wnl
    msk: no pain simulated on resisted eversion, plantar flexion, dorsiflexion, no pain elicited on inversion stretch of peroneal tendons/muscles. mild weakness is noted to r/leg muscles compared to l.

    I am thinking along the lines of a compression issue to the common peroneal from below knee compression stockings and have sent the patient for traction massage, and advised to try alternate full length compression therapy. Also I have given her strengthening exercises I considered some form of CRPS but found no muscular dystrophy to the area.

    Any thoughts would be great

  2. Ideology

    Ideology Active Member

    Sounds neurological but unusual. Might be irritation of the CPN due to top of stockings so your idea of full length is sound, or any of the other conditions present. Tinel's sign?
  3. bralph

    bralph Welcome New Poster

    I am thinking possible compression of common fibular nerve in vicinity of the fibular tunnel. Referral to physio for neural gliding and if if no result then surgical opinion for decompression surgery around fibular?
  4. sspod2001

    sspod2001 Active Member

    Thanks guys, an update from the patient recently she experienced an increase in pain from the traction massage and then all of a sudden she had 3 days with no pain what so ever, now the problem is back worse than before. I'm definitely heading along the possibility of a compression or lesion of CPN.

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