56: Exertional Compartment Syndrome - Yoho Flashcards
pathophysiology of exertional compartment syndrome
- Increased tissue pressure from decreased fascial envelop or increase in volume of the compartment.
- Increased compartmental pressure leads to increased venous pressure and reduced local arterio-venous
gradient
normal resting compartment pressure
0-8 mmHg
s/s chronic compartment syndrome
- pain with activity resolves with rest, however, variable
- duration symptoms persist after activity is stopped
- sensation of cramping or tightness with athletic activity
- complaints of weakness of extremity with athletic activity
- neurological abnormalities during and for a period after
- activity tightness of tautness on palpation of the involved compartment
- 50% of patients with anterior chronic compartment
- syndrome present with fascial defects
- able to recreate symptoms in office setting with exercise
- biomechanical faults/imbalances
compartment pressure criteria
normal is 0-8 mm Hg at rest
pre-exercise or resting pressure: = or > 15 mm Hg
one minute post-exercise pressure: = or > 30 mm Hg
five minute post-exercise pressure: = or > 20 mm Hg
thirty minute post-exercise pressure: slightly > pre-exercise pressure
conservative tx
- stop athletic activity 2-3 weeks
- graduated return/change to non-provocative athletic activity
surgical tx
- decompression of involved compartment
- crutch assistance ambulation first 2 weeks
- alternative athletic activity
- no running for four week
ddx for medial tibial stress syndrome (not a diagnosis itself)
- Periostitis/Soleus Syndrome/Posterior medial shin splints
- Chronic compartment syndrome
- Stress fracture
- Myositis
etiology posterior medial shin splints/periostitis
- overuse injury
- biomechanical/hyperpronation
- combination
- progression of myositis
s/s posterior medial shin splints
- Pain induced by activity, relieved by rest
- Dull ache to intense pain
- Tenderness distal posterior medial tibia
- Localized longitudinal fusiform firm swelling
- Lack of neurological or vascular abnormalities
- Pronated foot
pathophysiology of posterior medial shin splints/ periostitis
- Repetitive impact loading with hyperpronation results in
tension along the investing fascia of the distal fibers of the soleus muscle. - Continuous stretching of these structures results in a periostitis.
- There is controversy regarding the role of the tibialis posterior muscle. Its anatomic proximal attachment is posterior lateral rather than posterior medial aspect of the tibia * this is why we call it soleus syndrome instead*
what rules out taking pressure measurements?
no neurological symptoms
- order a Tc99 to look for patterns of uptake if you suspect posterior medial shin splints with a normal xray
tx posterior medial shin splints
- reduction in activity
- RICE
- NSAIDS (analgesic)
- address biomechanical issues
if unresponsive … surgical release of fascia attachment into posterior medial aspect of tibia
s/s stress fracture
- Localized pain and tenderness
- Swelling
- Palpable firmness related to cortical
- Hypertrophy or periosteal new bone formation
- Pain with activity
pathophysiology of stress fractures
- Repetitive compression and impact loading forces resulting in decreased cellular response and inadequate or insufficient remodeling of stressed
- Fatigue and failure of osseous homeostatic mechanisms
- Decreased electrical activity as determined by the piezoelectric phenomenon
what differentials are included in anterior tibial stress syndrome?
- myositis
- anterior tibial shin splints
- stress fracture
- anterior compartment syndrome
s/s ATSS
- Pain along lateral tibial crest
- Localized tenderness and swelling
- Pain with activity
- Post-static dyskinesia
pain with uphill running
anterior tibial shin splints FATIGUE
( tight posterior m. group/ weak anterior group due to sagittal plane imbalance)
tx with heel lift/strengthen ant tib, decreased hill running, stretch gastroc
pain with downhill running
TENSION anterior tibial shin splints
Frontal plane imbalance
Tight tibialis anterior
Excessive pronation
Pain with downhill running
stretch anterior tibialis, address pronation
