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Pretibial Soft-Tissue Lesions Produced by Chronic Ladder Rung Contact

John V. Gaeuman, MD
JAMA. 1984;251(13):1683. doi:10.1001/jama.1984.03340370023017.
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To the Editor.—  The telltale impressions left on the anatomy of physiology of the tradesman or artisan are often characteristic of the particular craft. As such, even if they produce no functional impairment, they serve as interesting clues to the identity of the specific activity.

Report of Cases.—  On two recent but separate occasions, I examined two maintenance electricians who spent a great proportion of their time working on overhead electrical service lines above drop ceilings, always standing on a ladder while thus engaged. The first was a 46-year-old man who was generally in good health. On both anterior midtibial surfaces he had 7-cm swellings, which were relatively soft and fluctuant but with a granular consistency. The overlying skin was slightly thickened and lichenified. There was no evidence of acute inflammation or cellulitis (Figure). Roentgenograms taken of the tibia showed no suggestion of periostitis. These lesions had been present for


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