Compartment Syndrome

Acute vs. ChronicTreatment Methods

Differential Diagnoses

Definition

• Compartment Syndrome “is a clinical condition in which increased pressure within a closed anatomical space compromises the circulation and function of the tissues within that space”- AAPSM

Acute Compartment Syndrome

• Causes– Trauma

• Fractures• Contusions• Surgery• Post Ischemic swelling after arterial occlusion• Major vascular trauma• Crush injuries• Burns• Prolonged limb compression

Signs and Symptoms• Increased Pressure and Tightness• Progressive pain out of proportion to initial injury• Markedly swollen area• Progressive neurologic deficit• Seven P’s

– Pain– Pressure– Pain with passive stretch– Parethesia– Paresis/ Paralysis– Pulses– Pallor

• Other Co-Morbidities

Chronic Compartment Syndrome

• EMG and nerve conduction studies normal at rest

• Most Common location:– Anterior Compartment of leg– Deep Posterior Compartment of leg

Signs and Symptoms

• Acute• Chronic

– Pain induced by athletic activity– Pain located along specific muscle group– Numbness and tingling along dermatomes

involved (depending on severity)– Pain occurs during specific training point– “Second- day Phenomenon”

Diagnosis• Gold Standard: Clinical Experience• Intramuscular Pressure testing• ACS: must be diagnosed and treated promptly

– Guidelines:• Compartment Pressure >30mm Hg• Pressure increases to within 20mm Hg of Diastolic BP• Use of MRI or Ultrasound to see decreased blood flow or nerve

entrapment

• CCS: Average time frame is 2.6 years– Guidelines:

• Rest compartment pressure 20-30mm Hg• After activity- 80- 150mm Hg• Delay to return to normal about 5-10 minutes**

Intracompartmental Pressure Test

Fasciotomy

Treatment Methods• Acute

– Surgical Decompression– Fasciotomy– Post-op Physical Therapy

• Chronic– Conservative methods (4-6 wks)

• Physical Therapy• Proper Training techniques• Muscle imbalance• Aquatic Therapy• Pt. Education• Flexibility training• Manual- deep tissue work• NSAIDs and Diuretics

– Fasciotomy• 90% success rate

Differential Diagnoses

• Medial Tibial Stress Syndrome (Shin Splints)• Stress Fracture • Periositis• Tenosynovitis• Arterial entrapment syndromes• Disc Disease• Radiculopathy • McArdle’s Syndrome (rare)

Questions??

BibliographyBouche, R. (n.d.). Chronic Compartment Syndrome. In American Academy of Podiatric Sports

Medicine Articles and Resources. Retrieved June 24, 2008, from American Academy of Podiatric Sports Medicne Website: http://www.aapsm.org/ chroniccomartment.html

Cluett, J. (2007). Exertional Compartment Syndrome. In Your Guide to Orthopedics. Retrieved June 24, 2008, from http://orthopedics.about.com

Edmundsson, D., Toolanen, G., & Sojka, P. (2007). Chronic Compartment Syndrome also Affects Non-Athletic Subjects. Acta Orthopaedica, 78(1), 136-143.

Golden, D. W., Flik, K. R., Turner, D. A., Bach, B. R., Jr., & Sawyer, J. R. (2005, December). Acute Compartment Syndrome of the Thigh in a High School Soccer Player. The Physician and Sportsmedicine, 33(12), 19-24.

Reid, D. C. (1992). Exercise-Induced Leg Pain. In Sports Injury Assessment and Rehabilitation (pp. 269-300). New York: Churchill Livingstone.