Differentials
Deep vein thrombosis
SIGNS / SYMPTOMS
Erythaema, collateral superficial veins, Wells score ≥2.
INVESTIGATIONS
Ultrasound may detect thrombus in paired posterior tibial veins, paired anterior tibial veins, and paired peroneal veins.
D-dimer may be raised.
Stress fracture
SIGNS / SYMPTOMS
Significant tenderness to palpation over the fractured site.
INVESTIGATIONS
X-ray shows fracture. Compartment pressure is normal.
Acute ischaemia
SIGNS / SYMPTOMS
History of claudication and absence of peripheral pulses.
INVESTIGATIONS
Duplex ultrasound may show peak systolic velocity ratio >2.0. Continuous-wave Doppler ultrasound may show pulsatility index decrease between adjacent proximal and distal anatomical segments.
Compartment pressure is normal.
Chronic venous insufficiency
SIGNS / SYMPTOMS
Obvious varicose veins on physical examination.
INVESTIGATIONS
Duplex ultrasound, assessing for reversed flow, may show valve closure time >0.5 second (indicating reflux).
Compartment pressure is normal.
Muscle tear
SIGNS / SYMPTOMS
Significant tenderness to palpation over affected muscle; possible overlying ecchymosis.
INVESTIGATIONS
Ultrasound may demonstrate grading of muscle damage: generalised or focal hyperechogenicity (grade 1), interruption of fibres in the echogenic perimysial striae (grade 2), rounded and hyperechogenic appearance of muscle stump (grade 3).
Compartment pressure is normal.
Haematoma
SIGNS / SYMPTOMS
Tenderness to palpation and possible overlying ecchymosis.
INVESTIGATIONS
Compartment pressure is normal.
Extremity fracture
SIGNS / SYMPTOMS
Significant tenderness to palpation over the fractured site. Absence of tight compartment on physical examination.
INVESTIGATIONS
X-ray shows the fracture. Compartment pressure is normal.
Tight casts, dressings, external wrappings
SIGNS / SYMPTOMS
Relief of symptoms with removal of casts, dressings, wrappings.
INVESTIGATIONS
Differentiating tests not needed if symptoms improve after removal of casts, dressings, wrappings.
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