RehabEdge Physical Therapy Forum

Forums  Register  Login  Forgot Login?
  My Profile 
My Subscription
  My Forums 
Search
  FAQ  Log Out
Follow @RehabEdge

Deep dull ache

 
Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Radiology Case Studies >> Deep dull ache Page: [1]
Login
Message << Older Topic   Newer Topic >>
Deep dull ache - September 23, 2005 4:20:00 AM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: March 1, 2004
From: Kentucky
Status: offline
60 year old male tripped in his house 4 weeks ago and suffered a laceration over the anterior tibia. A week later the wound was not healed and he had pain and swelling over the anterior tibia. He is a smoker, obese, and has Type II DM. The wound still is not healed and he has had two separate surgeries for wound management. He now complains of a deep dull ache from the mid leg down to his ankle. Radiographs were obtained.

What are the findings?

[IMG][/IMG]

[IMG][/IMG]

< Message edited by David Adamczyk -- July 20, 2007 2:31:19 AM >


_____________________________

Alex Brenner, PT, MPT, OCS
Post #: 1
Re: Deep dull ache - September 23, 2005 2:17:00 PM   
Synergy

 

Posts: 619
Joined: March 12, 2004
From: Texas
Status: offline
I see something in his medial malleolus (first film) that appears to be a non-displaced fracture, but cannot see it in the 2nd film. Given his history of diabetes and poor wound closure, osteomyelitis comes to mind as well. Interesting case! :)

_____________________________

Chris Adams, PT, MPT

(in reply to Alex Brenner PT MPT OCS)
Post #: 2
Re: Deep dull ache - September 23, 2005 4:42:00 PM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
Im going with Chris on the osteomyelitis. Hes smart.

_____________________________

Steve Hill PT

(in reply to Alex Brenner PT MPT OCS)
Post #: 3
Re: Deep dull ache - September 23, 2005 7:11:00 PM   
UTDC

 

Posts: 222
Joined: December 22, 2003
Status: offline
Hey Chris,
I think what you are seeing is the overlying fibula. The osseous structure look ok to me, except a small ovid lucency at the medial malleolus (not concerning) however there is a soft tissue abnormality anterior to the tibia. Infection.

(in reply to Alex Brenner PT MPT OCS)
Post #: 4
Re: Deep dull ache - September 23, 2005 7:56:00 PM   
jma

 

Posts: 2639
Joined: August 25, 2000
From: NY
Status: offline
Osteomyelitis sounds about right. Ws there any fever involved a well? Periosteal reactions and soft tissue component (cloudiness of radiograph) as well.

(in reply to Alex Brenner PT MPT OCS)
Post #: 5
Re: Deep dull ache - September 23, 2005 9:14:00 PM   
Synergy

 

Posts: 619
Joined: March 12, 2004
From: Texas
Status: offline
UTDC,

Thanks for correcting my apparent oversight. After looking at it again, I agree with you. I still think the OM may be an issue. Judging by these films, if it is OM then it's quite early because there are no visible (at least to me) periosteal reactions, but these may be better seen via CT or bone scan.

_____________________________

Chris Adams, PT, MPT

(in reply to Alex Brenner PT MPT OCS)
Post #: 6
Re: Deep dull ache - September 25, 2005 5:59:00 PM   
UTDC

 

Posts: 222
Joined: December 22, 2003
Status: offline
I see no evidence of osteomyelitis. The only abnormality I see is in the soft tissues. It is probably necrotizing fasciitis...just kidding. In any case, I'm sure Dr. Wagner could give us some valuble input on this one.


Jeff

(in reply to Alex Brenner PT MPT OCS)
Post #: 7
Re: Deep dull ache - September 26, 2005 6:44:00 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
I see a soft tissue lesion that seems to move when I scroll down....oh, wait. That's a fingerprint on my screen...

_____________________________

Mundi vult decipi

(in reply to Alex Brenner PT MPT OCS)
Post #: 8
Re: Deep dull ache - September 26, 2005 6:22:00 PM   
ehanso

 

Posts: 392
Joined: September 15, 2004
From: Minnesota
Status: offline
Interesting angulation of the proximal fibula. I am not sure if this is real or just the artifact from my lineless trifocals.

(in reply to Alex Brenner PT MPT OCS)
Post #: 9
Re: Deep dull ache - September 27, 2005 3:57:00 AM   
pkimm

 

Posts: 5
Joined: August 13, 2005
From: SoCal
Status: offline
Leg looks swollen! Can it be some kind of vascular problem or infection of some sort...it could be osteomyelitis but the bone looks normal.

_____________________________

DC Student

(in reply to Alex Brenner PT MPT OCS)
Post #: 10
Re: Deep dull ache - September 27, 2005 6:23:00 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Any signs of compartment syndrome? And that IS an interesting little curve in that fibula, but it looks old.

_____________________________

Mundi vult decipi

(in reply to Alex Brenner PT MPT OCS)
Post #: 11
Re: Deep dull ache - September 29, 2005 11:21:00 PM   
chiroortho

 

Posts: 691
Joined: February 19, 2004
Status: offline
I think evolving osteomyelitis and compartment syndrome are very reasonable, taking into account the limited history and films that are presented here. The fibula is completely normal in these projections.

As an aside, as you know the 5 'P's' of Volkmann's ischemia might also apply on clinical exam:
-pulselessness
-pain (earliest sign of compartment syndrome)
-paresthesia
-pallor
-paralysis

_____________________________

Greg Priest, DC, DABCO

(in reply to Alex Brenner PT MPT OCS)
Post #: 12
Re: Deep dull ache - September 30, 2005 10:51:00 AM   
MickeyPT

 

Posts: 41
Joined: May 2, 2004
From: USA
Status: offline
I don't see any signs of OM in this radiograph. Sure the patients history and presentation would lead my thoughts in that direction but there still appears to be pathology in the distal tibia. I don't think it is in the medial malleolus however but it does present (and appear) to resemble a Tillaux Fracture. Even though this is primarily an adolescent condition, I don't think it would be an unreasonable occurrence given this patients age and history.

_____________________________

Michael McIntosh PT, MBA

(in reply to Alex Brenner PT MPT OCS)
Post #: 13
Re: Deep dull ache - September 30, 2005 11:20:00 AM   
MickeyPT

 

Posts: 41
Joined: May 2, 2004
From: USA
Status: offline
Differentially I may also consider fracture of the Posterior malleolus (a.k.a. posterior articular margin) which may be more likely going by the size of the fx. and patients age.

_____________________________

Michael McIntosh PT, MBA

(in reply to Alex Brenner PT MPT OCS)
Post #: 14
Re: Deep dull ache - October 4, 2005 2:42:00 AM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: March 1, 2004
From: Kentucky
Status: offline
FINDINGS: AP and lateral views of the left tibia and fibula were obtained. A lucent soft tissue defect is noted along the anterior leg in the mid to lower region. The distal tibia has an irregularly linear lucency measuring 3.4 cm in length, extending to the articular surface. There is intermixed lucency and sclerosis along the medial malleolus and distal tibial metaphysis. Diffuse soft tissue swelling is present.

IMPRESSION: Findings in the distal tibia are concerning for osteomyelitis. A soft tissue ulcer is noted in the mid to distal anterior leg.

[IMG][/IMG]

< Message edited by David Adamczyk -- July 20, 2007 2:32:03 AM >


_____________________________

Alex Brenner, PT, MPT, OCS

(in reply to Alex Brenner PT MPT OCS)
Post #: 15
Page:   [1]
All Forums >> [RehabEdge Forum] >> Radiology Case Studies >> Deep dull ache Page: [1]
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.188