Compartment Syndrome Case

Question 1

What should be considered in the “shin splints” differential diagnosis?

Answer 1

stress fractures

medial tibial syndrome

comaprtment syndromes (anterior or deep posterior)

Question 2

What causes stress fractures?

Answer 2

it’s an overuse injury that occurs when muscles become fatigued and unable to aborb shock so the force is transferred to the weight bearing bones and eventually causes fractures

Question 3

where do stress fractures most often occur?

Answer 3

in the lower leg and feet

Question 4

What is the primary symptom of a stress fracture?

Answer 4

pain with activity that subsides with rest

Question 5

How do you diagnose a stress fracture?

Answer 5

clinical history/presentation and

x-ray, MRI or bone scan

x-ray won’t show an acute stress fracture but can find a healing one

Question 6

What is medial tibial syndrome? WHere does it most often occur?

Answer 6

you get tibial periostitis, most commonly at the distal one-third of the medial border of the tibia where the soleus inserts

Question 7

What will you find on physical exam with a medial tibial syndrome?

Answer 7

pain on palpation of the distal tibia over a length of 5 cm

Question 8

What is the treatment for medial tibial syndrome?

Answer 8

rest

Question 9

In general, what is a compartment syndrome?

Answer 9

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

Question 10

Which compartment of the leg is most often involved in compartment syndrome?

Answer 10

anterior

Question 11

What lab test did we do to suggest compartment syndrome?

Answer 11

a creatine phosphatase kinase - it was elevated, suggesting muscle damage

Question 12

What is the most common cause of compartment syndrome?

Answer 12

fractures - both open and closed…

followed by blunt trauma, casts, burns, exertional states (like out patient), IV lines, snake bites, hemophilia, etc.

Question 13

The incidence of compartment syndrome post fracture is proportional to what?

In what types of fractures is it most common?

Answer 13

the degree of injury to soft tissue and bone

most often with a cominuted grade 3 open injury to a pedestrian

Question 14

What is considered normal tissue pressure within a comaprtment?

When is it considered emergent?

Answer 14

0-4 mmHg as rest and 8-10 with exertion

30 mmHg is when it’s really an issue (other sources say higher though)

Question 15

Which is damaged faster in a compartment syndrome, muscle or nerve?

Answer 15

nerve

either way, after 8 hours you can have irreversible changes

Question 16

What will patients present with if they have a compartment syndrome?

Answer 16

pain out of proportion

palpably tense compartment

pain with passive stretch

paresthesia/hypothesia

paralysis

pulselessness

pallor

THe ones in bold are the really concerning ones

Question 17

Of the symptoms, what are the most reliable signs of compartment syndrome?

Answer 17

pain on passive stretching and pain on palpation of the compartment

pain is the most important

Question 18

What is the treatment for an emergent compartment syndrome?

Answer 18

A fasciotomy or all 4 compartments (takes only 2 incisions though)

then apply a bulky compression dressing and stabilize with a splint

close after 3-5 days