Clinical Case 3

Question 1

Diff Dx Shin Splints

Answer 1

• Stress fractures
• Medial tibial syndrome
• Compartment syndromes

Anterior

Deep Posterior

Question 2

Stress fractures are _______ injury (cause)

Answer 2

overuse

•Occurs when muscles become fatigued and unable to absorb shock. Muscle overload shock is transferred to weight bearing bones

Question 3

Most stress fxs where?

Answer 3

bones of lower leg and foot

Question 4

stress fractures sxs

Answer 4

pain w/ activity, subsides w/ rest

Question 5

stress fractures dx

Answer 5

xray, MRI, bone scan

Question 6

stress fxs tx

Answer 6

rest

Question 7

Medial tibial syndrome - most common site

Answer 7

distal 1/2 of medial border of tibia (insertion of soleus)

Question 8

MTS pathology

Answer 8

not well understool, tibial periostitis

Question 9

mts dx and tx

Answer 9

PE (pain on palpation of distal tibia over length of 5 cm), rest

Question 10

A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space.

Answer 10

Compartment syndrome

Question 11

Compartment syndrome results in – (2)

Answer 11

Ischemia and necrosis

Question 12

Compartment syndrome most common cause

Answer 12

fracture

Question 13

Incidence of CS directly proportional to _____

Answer 13

degree of injury to soft tissue and bone

Question 14

CS occurred most often in association w/

Answer 14

•with a comminuted, grade-III open injury to a pedestrian

Question 15

2nd most common cause of CS

Answer 15

blunt trauma

Question 16

CS tissue survival

Answer 16

8 hrs for both - irreversible changes

Nerve conduction is lost in 1-2 hours of total ischemia and survive up to 4 hrs with only neuropraxia changes, while axonotmesis and irreversible changes occur after 8 hrs. Muscle may survive up to 4 hours with reversible changes, variable damage occurs by 6 hrs, and irreversible changes after 8 hrs under conditions of warm ischemia.

Question 17

CS dx (PE)

Answer 17

• Pain out of proportion
• Palpably tense compartment
• Pain with passive stretch

LATER (so want to catch before these)

• Paresthesia/hypoesthesia
• Paralysis
• Pulselessness/pallor

Question 18

Compartment syndrome labs/measurements

Answer 18

Pressure measurements (may not be necessary - don’t waste time)

Question 19

Surgical tx CS

Answer 19

FASCIOTOMY (all compartments!)

Question 20

CS Wound management

Answer 20

• 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