Presentation
An amateur athlete with pain in the lower legs, predominantly on the left, when exercising. Relief of symptoms when stopping the exercise.
Patient Data
Axial T1 and STIR show normal structures bilaterally without evidence of muscle edema, interstitial fluid or focal abnormality.
Marker on the skin indicates painful site.
We ask the patient to perform physical activity in which shows the pain (running).
After starting with the symptoms a new scan was performed.
STIR after stress show signal intensity of the muscles in the anterior compartments bilaterally consistent with muscle edema.
MRI Legs comparison pre & after exercise
Left: Coronal T1 - to reference.
Upper right: Axial STIR - before stress
Lower right: Axial STIR - after stress
Case Discussion
This is a typical case of chronic exertional anterior compartment syndrome in both legs.
The main differential diagnoses of muscle edema:
- muscle strain
- delay onset muscle soreness (DOMS)
- myositis
- deep vein thrombosis
- diabetic muscle infarct
- denervation hypertrophy
- medial tibial stress syndrome (shin splints)
None of these cases have normal MRI and edema only after stress.