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
