- Anterior Compartment Syndrome:
-
anterior compartment of leg is involved most often;
-
diff dx:
-
tibial and fibular stress frx;
-
shin splints
-
popliteal artery aneurysm
-
exam:
- variable weakness of toe extension;
- pain on passive toe flexion;
- diminished sensation in the first web space;
- references:
-
Chronic anterior-compartment syndrome of the leg. Results of treatment by fasciotomy.
-
Management of chronic exertional anterior compartment syndrome of the lower extremity.
- Posterior Compartment Syndrome: (see
posterior compartment)
-
exam:
- weakness of toe flexion and ankle inversion;
- pain on passive toe extension (may referr to the back of the leg)
- diminished sensation over the sole of the foot;
- references:
- The tibialis posterior muscle compartment. An unrecognized cause of exertional compartment syndrome.
Davey JR, Rorabeck CH, Fowler PJ:
Am J Sports Med 1984;12:391-397.
- Lateral Compartment Syndrome:
- signs and symptoms are similar to those of anterior tibial compartment syndrome, but
peroneus longus and
brevis muscles are involved;
- pain is usually absent anteriorly, but the muscles of the anterior compartment are paralyzed from ischemia of the deep peroneal nerve as it passes thru the
lateral compartment;
- at surgery, necrosis of peroneus longus & brevis muscles is found, but muscles of
anterior compartment appear normal;
- Exam:
- note presence of any fascial defects;
- standard motor, sensory, and vascular exam;
- anterior compartment:
- variable weakness of toe extension;
- pain on passive toe flexion;
- diminished sensation in the first web space;
- posterior compartment:
- weakness of toe flexion and ankle inversion;
- pain on passive toe extension (may referr to the back of the leg)
- diminished sensation over the sole of the foot;
- Non Operative Treatment:
- othotics with a medial wedge can be helpful in posterior compartment syndrome, but might make an
anterior compartment syndrome worse;
- Indications for Surgery:
- resting pressure as well as dynamic pressure studies should be performed to give the surgeon pressure profile of the patient;
- normal compartment pressures at rest are between 0 and 4 mm Hg;
- some say < 11 mm is normal;
- postexercise reading of greater than of 35 mm Hg is highly indicative of compartment syndrome & greater than 40 mm Hg is diagnostic;
- diagnostic threshold is > 15 mm Hg at rest & > 20 mm Hg at 5 minutes after exercise;
- references:
Chronic exercise-induced compartment pressure elevation measured with a miniaturized fluid pressure monitor.
A laboratory and clinical study.
Awbrey BJ, Sienkiewicz PS, Mankin HJ:
Am J Sports Med 1988;16:610-615.
Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Pedowitz RA, Hargens AR, Mubarak SJ, et al:
Am J Sports Med 1990;18:35-40.
Intracompartmental pressure increase on exertion in patients with chronic compartment syndrome in the leg.
- Technique: (chronic anterior compartment syndrome)
- see:
fasciotomy of the leg;
- decompression of anterior &
lateral compartments through subQ fasciotomy;
- use two vertical incisions (one distal and one proximal) centered over anterior intermuscular septum is preferred;
- if a fascial hernia is present, consider incorporating the fascial defect into the fasciotomy incision;
- often, the superficial peroneal nerve exits at the site of the hernia;
- intermuscular septum is identified;
-
fasciotomies are made 1 cm in front & 1 cm behind intermuscular septum;
- take care to identify and preserve terminal branch of deep
peroneal nerve;
- for chronic posterior compartment syndromes, posteromedial subQ fasciotomy is favored to protect saphenous vein and nerve;
- in this patient group, it is also necessary to identify tibialis posterior muscle belly and to decompress this muscle as well;
- once fascial defect is made it should never be repaired, because, after repair, acute compartment syndrome can ensue, w/ catastrophic consequence;
- references:
-
Chronic anterior-compartment syndrome of the leg. Results of treatment by fasciotomy.
The results of fasciotomy in the management of chronic exertional compartment syndrome. Rorabeck CH, Fowler PJ, Nott L: Am J Sports Med 1988;16:224-227.
Chronic leg pain in athletes due to a recurrent compartment syndrome.
Martens MA, Backaert M, Vermaut G, et al:
Am J Sports Med 1984;12:148-151.
Chronic exercised induced compartment pressure elevation measured with miniaturized fluid pressure monitor.
AW Bray et al.
Am J. Sports Medicine. Vol 16. 1988. p 610-615.
