Case Study: Leg Pain Flashcards
Differential Diagnosis “Shin Splints”
- Stress fractures
- Medial tibial syndrome
- Compartment syndromes
Anterior
Deep Posterior
•Occurs when muscles become fatigued and unable to absorb shock. Muscle overload shock is transferred to weight bearing bones
stress fractures
Stress fractures are _______ injury
overuse
Stress fractures most occur in __________
bones of lower leg and foot
Sxs stress fractures
pain w/ activity, subsides w/ rest
STress fractures dx
xray, MRI, bone scan
stress fractures tx
rest
Medial Tibial Syndrome
- Most common site is ______ of the _____ border of the _____
- Generally felt to be the insertion of the _____
- Pathology is an area of _______
- Most common site is distal one-third of the medial border of the tibia
- Generally felt to be the insertion of the soleus
- Pathology is an area of tibial periostitis
Medial Tibial Syndrome Dx
•physical exam, pain on palpation of the distal tibia over a length of 5 cm.
Medial tibial syndrome tx
rest
A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space.
Compartment syndrome
Compartment syndrome complications
- Reduces tissue perfusion - ischemia
- Results in cell death - necrosis
- True Orthopedic Emergency
Compartment Syndrome Etiology
- Fractures-closed and open
- Blunt trauma
- Cast/dressing
- Burns/electrical
- Exertional states
- Gunshot
- IV/A-lines
- Hemophiliac/coag
- Intraosseous IV(infant)
- Snake bite
- Arterial injury
Most common cause of compartment syndrome
Fracture (incidence of accompanying CS 9.1%)
CS incidence is directly proportional to the __________
degree of injury to soft tissue and bone (fracture)
Most common fracture occurence –> CS
•occurred most often in association with a comminuted, grade-III open injury to a pedestrian
2nd most common cause of CS
blunt trauma (about 23% of CS)
25% d/t direct blow
CS tissue survival
•Muscle
– 3-4 hours - reversible changes
–6 hours - variable damage
–8 hours - irreversible changes
•Nerve
–2 hours - looses nerve conduction
–4 hours - neuropraxia
–8 hours - irreversible changes
CS dx
- Pain out of proportion
- Palpably tense compartment
- Pain with passive stretch
- Paresthesia/hypoesthesia
- Paralysis
- Pulselessness/pallor
CS pain
most important. Especially pain out of proportion to the injury (child becoming more and more restless /needing more analgesia)
Pain on passive stretching and palpation of involved compartment
CS Pain vs other Ps
•Other features like pallor, pulselessness, paralysis, paraesthesia etc. appear very late and we should not wait for these things.
CS tx
fasciotomy - all compartments
CS wound management
- After the fasciotomy, a bulky compression dressing and a splint are applied.
- Incision for the fasciotomy usually can be closed after three to five days
Medial tibial syndrome is from the insertion of the:
soleus
The initial treatment of compartment syndrome is:
Fasciotomy
