Compartment Syndrome

There are many terms used to describe compartment syndromes:

Tibial syndrome; shin splints; exercise ischaemia and myositis (inflammation of muscle). It is currently known as “exertional compartment syndrome”.

A compartment, in this context, is a part of the leg that is bounded by bone, ligament, fascia (thick flat tissue) in which the muscle or muscle sits e.g. anterior compartment where the tibialis anterior muscle is bounded by the tibia (shin bone) and the fibula and deep fascia – ask everyone to have a feel.

Broadly defined as a condition in which increased pressure within a muscle compartment, brought about by increased effort or exercise, impedes the blood flow to that compartment.

The most common compartment syndromes occur in the lower leg, in particular the anterior or deep posterior compartment, but can also happen in the peroneal compartment – the outside part of the shin.

Common Symptoms

Pain, muscle tightness or swelling, a cramp like feeling, weakness or numbness during exercise. It usually occurs during weight bearing exercise e.g. walking, running, jumping. The patient will often complain it happens at about the same time or intensity of exercise e.g. 15 minutes into a run, a certain number of reps on the track.

The pain will often stop the patient from exercise, but as the problem becomes more chronic, it will take longer for the symptoms to abate.

Treatment of compartment syndrome

Acute – surgical emergency.

Chronic – conservative treatment may be of some benefit e.g. physiotherapy: deep massage of the compartments, ultrasound, interferential therapy, magnetic field therapy, a lot of stretching and ice. If it is not successful after 6 weeks, cessation of that particular sport or surgery should be considered.

Surgery – known as fasciotomy – which is the splitting of the deep tissues to allow more room for the muscles to expand. Pressure measurements are taken before and after surgery to determine success of the decompression. Post operatively, the patient gets range of motion exercises, weight bears as comfortable (usually with crutches the first few days and then weight-bearing fully ASAP. The biggest problems faced after this type of surgery are: wound breakdown and infection and haematoma formation – this can create scar tissue around the fasciotomy and lead to a closing of the released area and hence a recurrence.

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