Trauma
If a patient has a history of recent trauma to an area where DVTs frequently occur, there could be several musculoskeletal complications that may mimic a DVT or occur in conjunction with a DVT. The following are some of the most common conditions that may be considered.
Hematoma
Trauma to the calf region is commonly caused by a muscular strain to the gastrocnemius or soleus muscle. Complete or partial tears of these muscles can result in a hematoma. This can cause local swelling, pain, and tenderness activated by ankle movements. These symptoms can mimic that of a DVT. A history of the injury and exam can aid with diagnosis, and a CT scan can be definitive in identifying a hematoma.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention.
McGraw-Hill/Appleton & Lange; 2008, (pg.319).
Trauma to the calf region is commonly caused by a muscular strain to the gastrocnemius or soleus muscle. Complete or partial tears of these muscles can result in a hematoma. This can cause local swelling, pain, and tenderness activated by ankle movements. These symptoms can mimic that of a DVT. A history of the injury and exam can aid with diagnosis, and a CT scan can be definitive in identifying a hematoma.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention.
McGraw-Hill/Appleton & Lange; 2008, (pg.319).
Fracture
A fracture to the shaft of the fibular or tibial bone can also mimic that of DVT. These fractures are usually caused by a direct trauma to the lower leg. Fibular stress factures can also occur and are common in long distance runners. Symptoms of these fractures include: pain in weight bearing and over fracture site, leg deformity, occasional loss of feeling in leg or foot, and even bone "tenting" or protrusion through skin break.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill/Appleton & Lange; 2008,
(pg.319).
A fracture to the shaft of the fibular or tibial bone can also mimic that of DVT. These fractures are usually caused by a direct trauma to the lower leg. Fibular stress factures can also occur and are common in long distance runners. Symptoms of these fractures include: pain in weight bearing and over fracture site, leg deformity, occasional loss of feeling in leg or foot, and even bone "tenting" or protrusion through skin break.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill/Appleton & Lange; 2008,
(pg.319).
Compartment Syndrome
Acute Compartment Syndrome is caused by a rapid increase in the volume of a fascia-contained compartment, especially in the leg and forearm. It often follows a moderate to severe trauma, and is often caused by a ruptured artery increasing pressure within the fascia. It is considered a surgical emergency, as exposing the compartment's tissues to prolonged increased pressure can cause death of muscle, nerve and vascular tissue.
The superficial posterior compartment of the lower leg is most likely to mimic a DVT because of location and symptoms including pain and a palpably tense and painful compartment. However, because no major arteries run through this compartment, it is the least likely compartment to be affected. Other more common sites include:
Deep posterior compartment, with symptoms including pain with passive toe extension, weakness with toe flexion, decreased sensation on plantar surface of foot.
Lateral Compartment, which may result in weakness in dorsiflexion and inversion, as well as decreased sensation to lower leg and dorsum of the foot.
Anterior Compartment, the most common site for acute compartment syndrome. Signs include weakness in dorsiflexion, foot drop, claw foot, and deep peroneal nerve dysfunction.
Stracciolini, A. Hammerburg M. (2013) "Acute Compartment Syndrome of the Extremities." UpToDate.
Acute Compartment Syndrome is caused by a rapid increase in the volume of a fascia-contained compartment, especially in the leg and forearm. It often follows a moderate to severe trauma, and is often caused by a ruptured artery increasing pressure within the fascia. It is considered a surgical emergency, as exposing the compartment's tissues to prolonged increased pressure can cause death of muscle, nerve and vascular tissue.
The superficial posterior compartment of the lower leg is most likely to mimic a DVT because of location and symptoms including pain and a palpably tense and painful compartment. However, because no major arteries run through this compartment, it is the least likely compartment to be affected. Other more common sites include:
Deep posterior compartment, with symptoms including pain with passive toe extension, weakness with toe flexion, decreased sensation on plantar surface of foot.
Lateral Compartment, which may result in weakness in dorsiflexion and inversion, as well as decreased sensation to lower leg and dorsum of the foot.
Anterior Compartment, the most common site for acute compartment syndrome. Signs include weakness in dorsiflexion, foot drop, claw foot, and deep peroneal nerve dysfunction.
Stracciolini, A. Hammerburg M. (2013) "Acute Compartment Syndrome of the Extremities." UpToDate.
Osteomyelitis
Osteomyelitis is an infection of the bone, and can result from a nearby infection of the soft tissues or by introduction of a pathogen from a trauma. Symptoms will have a gradually worsening onset over several days, and may include fever and dull pain at the involved site, as well as localized tenderness, warmth, redness and swelling. Treatment may include aggressive antiobotic therapy and surgical resection of necrotic tissue.
Lalani, T. (2012) "Overview of osteomyelitis" UpToDate.
Osteomyelitis is an infection of the bone, and can result from a nearby infection of the soft tissues or by introduction of a pathogen from a trauma. Symptoms will have a gradually worsening onset over several days, and may include fever and dull pain at the involved site, as well as localized tenderness, warmth, redness and swelling. Treatment may include aggressive antiobotic therapy and surgical resection of necrotic tissue.
Lalani, T. (2012) "Overview of osteomyelitis" UpToDate.