Physician's Assistant

Sdec Fri 27 June 2025 16:17

Last Modified: 283 days ago

MRN:

Content:

Presenting Complaint:
Left leg swelling and pain

Past Medical History
• Left knee replacement 18 months ago
• Previous Achilles tendon rupture (opposite leg)

Diagnosis:
Suspected ruptured Baker's cyst vs Achilles tendon injury

I had the pleasure of meeting Mr William Ayers in Same Day Emergency Care today.

Mr Ayers is an 79-year-old retired lorry driver who presented with a 1-day history of left leg swelling and pain. The symptoms began as an ache in the lower leg yesterday, progressing to obvious swelling. The swelling extends from the ankle to the knee, with significant tenderness particularly around the achilles . He denies any trauma or precipitating event. Of note, he has a history of left knee replacement 18 months ago with good recovery, and previous Achilles tendon rupture on the contralateral side during weight training.

On examination, there was visible swelling of the left lower leg extending from ankle to knee level. The leg appeared slightly darker than the contralateral side but without erythema. Ankle dorsiflexion was extremely painful and limited, whilst plantarflexion was tolerable. The knee prosthesis appeared well positioned without swelling or warmth.

Social history reveals he lives with his wife, is a social smoker, and drinks alcohol occasionally. He has been using crutches for mobility.

Investigations:
Creatinine: 112 (previous 114 in May 2024)
Electrolytes: Normal
LFTs: Normal
D-dimer: 0.4 (negative)
FBC: Normal
Venous blood gas: Normal
ESR: 0
ECG: Right bundle branch block, left axis deviation, PR 208ms, first degree AV block. Repeated and PR 188ms, bifascicular block.

Plan:
1. Analgesia
2. Orthopaedic review for assessment of suspected achilles tendon pathology

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Summary:

Investigations:

Sdec Fri 27 June 2025 16:17

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