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Hi
I have recently had a patient that came in complaining that she had regular bruising in her proximal tibia following a fall she had that knocked this area quite hard. Now 18 months after the fall she gets spontaneous haematoma formation in this area?
on palpation the bone was tender.
possible infection of the bone?
Many questions first:
Are there any scans at all?
Where is the location of the haematoma exactly? Anterior aspect over the tibial tuberosity?
Is there actual bruising over the soft tissue - ie yellow/purple/green bruising like it was knocked?
Does resisted quads cause pain?
Flat feet?
Any problems with the quads/patella tendon, or infrapatella fat pad?
Is it truly spontaneous, as in not associated with a particular activity, running/walking/steps etc?
How old is she? If <14-15yo, then consider Osgood-Schlatters.
Otherwise tendon or PFJ problem, or stress fracture.
If not associated with mechanical loading then perhaps infection.
I tend to agree with the above question re: X-rays at least. One would want a close examination of any boney lesion before commenting. How are you diagnosing a haematoma? i.e. bleeding causing the swelling. She may have just traumatized some superficial vessels that are easily damaged each time they are knocked, hence recurrent bruising.
Any image you can post for us? Is there any issue with dorsiflexion contractions? Infection would usually be clinically considered if there is warmth in that area compared to the other leg. Of course fresh bleeding could do the same. Let's get a plain x-ray as a starting point.
Hi
Thank you for the interest shown.
She is scheduled to have X-rays taken soon so will be able to comment on that soon.
It is truly spontaneous-no specific movement or action that elicits this response.
No flat feet.
No problems with the infrapatellar fat pad/tendon.
Resisted quads not a problem.
It literally forms a small haematoma as in blue discolouartion under the skin over the proximal tibia(not tuberosity).
What worries me is that the whole tibia has increased sensitivity on palpation.
I will keep you updated if I have more answers.
Hi.
While waiting for the x-rays you may want to try the tuning test fork
Can tuning forks replace bone scans for identifica... [Mil Med. 1997] - PubMed result
I mean, it does not definitely rule out a fracture.. but I would try, especially if the x-rays are scheduled too much later on.
The tuning fork test is a really handy tool but only is useful in superficial fractures for suggesting a likelihood of a fracture e.g. on fingers or metatarsals. So to are srpin tests of the bone and even therpeutic ultrasound to diagnose the fracture e.g. it will elicit pain over the fracture site. Not sure any of that will help with an older injury and one whose issue now is the recurrent bruising. But thanks for mentioning the test as I use it all the time.