![]() Passive hip and knee movements were possible but limited by pain. Straight-leg raise was possible to 30 degrees, with no palpable gap in the quadriceps mechanism. He displayed hyperesthesia in the thigh anterolaterally, with preserved sensorimotor function and pulses distally in the limb. ![]() The swelling was non-pulsatile with no audible bruit. It was exquisitely tender as well, with an extremely tense anterior compartment. It was swollen, with a mid-thigh circumference 12 cm larger than on the right side. On local examination, there was no obvious wound or bruising over the left thigh. His abdomen was soft and non-tender in all quadrants, with no palpable masses. He was tachypneic (respiratory rate 26/min), but a cardiovascular and pulmonary examination was otherwise unremarkable. He was afebrile, with a pulse rate of 90/min, blood pressure of 145/90 mmHg. He looked in distress and complained of a severe “bursting” pain, despite having had 10 mg of intravenous (IV) morphine, 1 gm of paracetamol and 50 mg of diclofenac in the preceding hour. He was examined by the on-call orthopedic resident at 11PM, nearly an hour after he presented to ED. The pain worsened dramatically on the night of ED presentation, such that he was unable to weight-bear and required copious amounts of analgesics, with limited effect. This pain did not inhibit him from going to work over the next week and he was able to bear all his weight through both legs. He did not lie on his bed awkwardly that night, but woke up with a dull ache in his left thigh the next morning. He had gone out with friends a week earlier, but could not recall any incidental trauma. He used to run half-marathons, but had not run for at least four months. The patient, who worked at a food retail shop, was normally fit and well and did not take any medication routinely. This ED is part of a Level I trauma center in the southwest of England that sees 68,000 patients annually. 2 Given this clinical suspicion, a prompt clinical decision can prove limb-saving.Ī 27-year-old man presented to the emergency department (ED) with severe pain in his left thigh. 1, 2 Because there is usually an etiological basis for it in the patient’s history, it would be an unlikely diagnosis in a patient presenting without a suggestive history or mechanism of injury. However, the past decade has seen a surge in thigh presentations being diagnosed and managed. ![]() Although extensively described in legs, their occurrence in the thigh has been rare. INTRODUCTIONĬompartment syndromes are orthopedic emergencies. Emergency physicians and traumatologists should be cognisant of spontaneous atraumatic presentations of thigh compartment syndrome, to ensure prompt referral and definitive management of this limb-threatening condition. A review of thigh compartment syndromes described in literature is presented in a table. No pathology could be identified intra-operatively, or on follow-up imaging. Preliminary imaging delineated a haematoma in the anterior thigh, without any fractures or muscle trauma. A young man presented with a painful and swollen thigh, without any history of trauma, illness, coagulopathic medication or recent exertional exercise.
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