Compartment Syndrome
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Compartment syndromes are potentially serious athletic injuries. A compartment syndrome is the result of unusually high pressure in one of the four compartments in the lower leg. The compartments do not tolerate vast changes in pressure. If the pressure increases too much, pain and disability can result. Anatomy Each of the compartments are “sealed” spaces containing muscles, arteries, and nerves. Each compartment contains the following major nerves, arteries and veins: the deep peroneal nerve, and anterior tibial artery and vein in the anterior; the superficial peroneal nerve in the lateral; the saphenous nerve in the superficial posterior; and the tibial nerve, posterior tibial artery and vein, and the peroneal artery and vein in the deep posterior. The muscles located in the compartments are as follows:
The superficial and deep compartments anatomical boundaries can vary. Both compartments are commonly involved in exertional compartment syndromes (ECS). The “soleus bridge” is a combination of fascia layers in the deep posterior compartment that are closely related to ECS. The bridge is formed by the transverse intermuscular septum and its intersection with the anterior and posterior fascial layers of the soleus. The bridge ultimately inserts on the posteromedial tibia. Due to its insertion point irritation of the bridge is often misdiagnosed as medial tibial stress syndrome. Also, increased compression of the bridge is seen in athletes with excessive rear foot pronation. Evaluation Acute compartment syndromes are medical emergencies that may require immediate surgical treatment. Acute compartment syndromes are usually the result of a traumatic incident such as a car accident. The shin is struck with an object that causes a deep contusion. The swelling from the contusion causes the increased pressure in the compartment. These injuries are most often seen in the emergency room and are not athletic injuries. ECS is seen more often in the athletic community. Diagnosing this injury is one of exclusion. A complete examination should rule out medial tibial stress syndrome, stress fractures, and Achilles tendon injuries. The athlete will present with pain that is present during weight bearing training. Activities such as running, stair climbing, and jumping are the most common offenders. Radiographs should be obtained to rule out occult stress fractures. The physical examination may not yield any significant findings. With a true ECS, a physical examination must be conducted immediately after cessation of the offending physical activity. An exam at this time should reveal a tense compartment or swollen lower leg, paresthesia, and non-focal pain on palpation. The ECS sufferer will not have point tenderness over the medial tibial border as seen with medial tibial stress syndrome. Definitive diagnosis of an ECS can be made with an intracompartmental pressure test. A catheter is inserted into the offending compartment to measure its pressure. Most often 3 pressure readings will be taken; resting, and 1 minute and 5 minutes post exercise. Most physicians rely solely on the post-exercise pressures to render a diagnosis. The pressures alone, are not relative; they must show an elevation from the resting pressure along with a recurrence in symptoms. Appropriate pressure reading are a subject of debate. Most physicians will follow these readings:
Once the diagnosis is confirmed with a positive compartment measurement, a treatment course is to be chosen. Conservative treatment is the first option. Rehabilitation should include: low impact cross training, flexibility training, appropriate strength training for weakened muscles, and/or the use of orthotics to correct biomechanical abnormalities. If conservative treatment fails, surgical intervention in the next step. A fasciotomy is the procedure of choice. A fasciotomy can be performed with one long incision over the affected compartment or with a newer method that involves two small incisions. The fascia over the affected compartment 1 cm posterior to the intermuscular septum. This will allow the compartment to increase in size due to the accommodate the higher pressures that occur during exercise. If the anterior or lateral compartments are affected, the surgeon will often release both. Anterior and lateral compartment releases have a high success rate. Release of the posterior and deep posterior compartments have a lower success rate. Researchers do not know the reason for this disparity. Full activities may begin as soon as tolerated, usually 3 to 4 weeks after surgery.
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©2000 - 2006 David Edell Information on this site is not a substitute for physician directed care. Please consult your personal physician for more detailed information concerning specific injuries or illnesses. Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM |
