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Thigh Myalgia - Football Kicker And Soccer

2021; Lippincott Williams & Wilkins; Volume: 53; Issue: 8S Linguagem: Inglês

10.1249/01.mss.0000763840.42168.a7

1530-0315

Eric Taylor Schmidt, Kerry S. Kuehl, Diane L. Elliot,

Cardiovascular Effects of Exercise

HISTORY: 16 yo healthy male high school placekicker presents with chronic, progressive worsening of BLE exertional weakness and pain. Over the last 3 years, he developed BLE fatigue / myalgia during exercise training, reporting "heaviness" and pain to the thighs occurring with exercise. Overtime, less exertion reproduces these symptoms and now occurs immediately during strength training or walking up one flight of stairs. Pain resolves quickly with rest. No symptoms in BUE, buttocks, or calves. He aspires to play D-1 college football but is forced to break from sports due to severity of symptoms. PHYSICAL EXAMINATION: Vitals unremarkable, BMI 22.4. General: Healthy well developed teenager in NAD. Cardiac: RRR with normal heart sounds. Negative for HCM. Abdomen: Soft, non-tender, no aortic bruit or pulsations. Extremities: Well perfused without deformities, edema, or skin discoloration. Peripheral pulses equal with good capillary refill. DIFFERENTIAL DIAGNOSIS: Metabolic Myopathy Muscular Dystrophy Rhabdomyolysis Exertional Compartment SyndromeIliac Endofibrosis Proximal Arterial Stenosis Popliteal Entrapment TEST AND RESULTS: Exercise Testing: oTest terminated due to leg fatigue and painoMetabolic Response: 15-fold increase in exercise lactate level (0.6 - > 10.3). CK mildly elevated post-exercise (250 - > 294). Ammonia level was normal pre- and post-exercise (19, 34). Acyl Carnitine results normal. Testosterone normaloCardiopulmonary Fitness Level: VO2 Max 52.7 mL/kg/minABI: ABNORMAL. Significant drop in ankle pressures BL with exercise (R 1.04 - > 0.61, L 1.07- > 0.63) c/w arterial insufficiency. Abd US: Patent arteries w/o stenosis. BLE ART US: Normal exam CTA AP: Normal. No iliac artery endofibrosis. CTA Chest: Normal. Angiogram: Inducible narrowing and transient occlusion of multiple small muscular perforator vessels off the profunda femoris bilaterally with exercise. Otherwise unremarkable BLE angiogram without large vessel compression, stenosis, aneurysm. FINAL WORKING DIAGNOSIS: Thigh Claudication Secondary to Profunda Femoris and Perforator Artery Compression Syndrome TREATMENT AND OUTCOMES: 1. Conservative Treatment with Aerobic Exercise and Physical Therapy for 12 months. 2. Interventional Surgery Considered if Treatment Fails and athlete cannot return to activity.