Calf pain Flashcards
Probability diagnosis
Simple muscular cramp
Muscle soreness (post exercise)
Muscle injury esp. gastrocnemius tear
Claudication esp. vascular (intermittent)
Serious disorders not to be missed
Vascular:
- Deep venous thrombosis
- Peripheral vascular disease
- Superficial thrombophlebitis
- Popliteal artery entrapment
Infection:
- Cellulitis
Other:
- Achilles tendon rupture
- Neurogenic claudication
- Deep posterior muscle compartment syndrome
Pitfalls (often missed)
Referred pain: knee, spine
Ruptured Baker’s cyst
Superficial posterior compartment syndrome
Nerve entrapment e.g. tibial, sural
Stress fracture of fibula
Rarities:
- Hypocalcaemia→cramps
- Motor neurone disease
Masquerades checklist
Diabetes
Drugs e.g. beta blockers
Thyroid/other endocrine: hypocalcaemia
Spinal dysfunction: L5 referred
Is the patient trying to tell me something?
Possibly muscle tension
Key history
Features of the pain-quality, onset (acute or slow), ‘tearing’ or ‘popping’ sound, relation to activity and associations esp. back or knee pain.
- Any preceding sporting activity
- travel
- immobilisation
- varicose veins or claudication—neurogenic or vascular pattern.
Key examination
Calf muscle examination incl.
- Achilles tendo
- functional stress
- swelling or bruising
Lumbosacral spine and knee of affected side
Veins and arteries of leg esp. peripheral pulses
Neurological—sensation, power, reflexes esp. ankle
Investigations
Nil for most cases.
Consider:
- FBE
- ESR/CRP
- muscle enzymes
- imaging e.g. ultrasound, D-dimer, venography, angiography
Claudication
Neurogenic claudication is
- muscular pain
- starting proximal and radiating distal on walking
- persists for a while after resting.
Vascular claudication;
- starts in the calf
- radiates proximal and
- abates on rest.
Diagnostic tips
Calf pain is usually not serious except if swelling is present.
Not to be missed DVT, thrombophlebitis
