Differential Diagnosis for Acute Compartment Syndrome
The patient's presentation of increasing pain, disproportionate to the injury, and sensory hypoesthesia after an impact injury to the anterior lower leg suggests acute compartment syndrome. However, it is crucial to consider other potential diagnoses.
Single most likely diagnosis:
- Acute compartment syndrome: This is the most likely diagnosis given the patient's symptoms of severe pain with active plantar flexion, which is disproportionate to the injury, and sensory hypoesthesia. These are classic signs of increased pressure within a closed fascial compartment.
Other Likely diagnoses:
- Achilles tendon rupture: Although the patient continued playing after the injury, an Achilles tendon rupture could present with severe pain and difficulty with plantar flexion. However, it typically presents with a more distinct snap or pop at the time of injury.
- DVT (Deep Vein Thrombosis): While less likely given the acute presentation after a traumatic injury, DVT could cause pain and swelling in the leg. However, it would not typically cause sensory hypoesthesia or pain specifically with active plantar flexion.
Do Not Miss diagnoses:
- Rhabdomyolysis: This condition, characterized by the breakdown of muscle tissue, can occur after severe muscle injury and can lead to serious complications like renal failure. The patient's continued activity after the injury increases the risk.
- Fat embolism: Although more commonly associated with long bone fractures, fat embolism syndrome is a potentially life-threatening condition that could present with vague symptoms initially, including pain and neurological changes.
Rare diagnoses:
- Inflammatory myositis: This would be an unusual diagnosis in the acute setting after a traumatic injury but could potentially cause muscle pain and weakness.
- Infectious myositis or cellulitis: While possible, especially if there was an open wound, these conditions would likely present with additional signs of infection such as fever, redness, and swelling.