Chapter 19 Flashcards
Compartment Syndrome
- increased pressure within one of the four components causing compression of muscular and neuromuscular structures
anterior and deep posterior compartments usually involved
Compartment Syndrome - Management
- immediate first aid for acute compartment syndrome
—> ice and elevation
—> no compression wrap - emergency fasciotomy to release pressure
- may not return to 2-4 months after fasciotomy
Compartment Syndrome - Signs and Symptoms
Red, hot shiny skin
- deep, aching pain
- tightness and swelling on involved compartment
- pain with passive stretching of involved muscles
- reduced circulation and sensory changes in foot
Compartment Syndrome Categories: Acute Compartment Syndrome
- occurs secondary to irect traume to the area
- medical emergency
Compartment Syndrome Categories: Acute Exertional Compartment Syndrome
- occurs without any precipitating trauma
- can evolve with minimal to moderate activity
Compartment Syndrome Categories: Chronic Compartment Syndrome
- activity related in that symptoms arise consistently at a certain point in the activity
- usually occurs during running and jumping activities
- symptoms cease when activity stops
Muscle Compartments: Anterior Compartment
- muscles that DF ankle and extend toes
Tib ant
extensor hallicus longus
extensor digitorum longus
anterior tibial nerve
tibial artery
Muscle Compartments: Deep Posterior Compartment
- tibialis posterior, flexor digitorum longus and flexor hallucis longus
- posterior tibial artery
Muscle Compartments: Lateral Compartment
- contains fibularis longus and brevis (peroneus)
- fibularis tertius (peroneus Tertius)
- superficial branch of peroneal nerve
Muscle Compartments: Superficial Compartment
- contains gastrocs and soleus to PF ankle
Ottawa Ankle Rules (3)
- Inability to WB for 4 steps at the time of injury and at the time of examination
- Tenderness over the inferior or posterior pole of either malleolus, including the distal 6cm
- Tenderness along the base of the fifth metatarsal of navicular bone
Special Tests: Anterior Drawer
- Tests ATFL
- ankle 90deg, grasp lower tib and calcaneus, push tibia back and pull calcaneus forward
- +’ve = foot sliding forward
Special Tests: Homan’s Sign
- indication of DVT
- pt supine, knee full extended, ankle passively DF
- +’ve = pain in the calf
** refer immediately **
Special Tests: Kleiger’s Test (External Rotation)
- determines injury to syndesmosis, ATFL, PTFL and interosseous membrane
- seated with legs over end of table
- stabilize lower leg, hold medial foot and rotate externally
- pain in ant lat ankle may indicate injury to syndesmosis
- pain over deltoid ligaments may indicate deltoid sprain
Special Tests: Medial Subtalar glide Test
- determines presence of excessive medial translation of calcaneus on talus in transverse plane
- hold talus in subtler neutral, glide calcaneus in medial direction of the fixed talus
- +’ve = excessive movement, indicating injury to lateral ligaments
