Compartment Syndrome

Acute vs. Chronic

Treatment Methods
Differential Diagnoses
Definition
Compartment Syndrome is a clinical
condition in which increased pressure
within a closed anatomical space
compromises the circulation and
function of the tissues within that
space- AAPSM
Acute Compartment Syndrome
Causes
Trauma
Fractures
Contusions
Surgery
Post Ischemic swelling after arterial occlusion
Major vascular trauma
Crush injuries
Burns
Prolonged limb compression

Signs and Symptoms
Increased Pressure and Tightness
Progressive pain out of proportion to initial
injury
Markedly swollen area
Progressive neurologic deficit
Seven Ps
Pain
Pressure
Pain with passive stretch
Parethesia
Paresis/ Paralysis
Pulses
Pallor
Other Co-Morbidities

Chronic Compartment Syndrome
EMG and nerve conduction studies
normal at rest
Most Common location:
Anterior Compartment of leg
Deep Posterior Compartment of leg

Signs and Symptoms
Acute
Chronic
Pain induced by athletic activity
Pain located along specific muscle group
Numbness and tingling along dermatomes
involved (depending on severity)
Pain occurs during specific training point
Second- day Phenomenon
Diagnosis
Gold Standard: Clinical Experience
Intramuscular Pressure testing
ACS: must be diagnosed and treated
promptly
Guidelines:
Compartment Pressure >30mm Hg
Pressure increases to within 20mm Hg of Diastolic BP
Use of MRI or Ultrasound to see decreased blood flow or
nerve entrapment
CCS: Average time frame is 2.6 years
Guidelines:
Rest compartment pressure 20-30mm Hg
After activity- 80- 150mm Hg
Delay to return to normal about 5-10 minutes**
Intracompartmental Pressure Test
Fasciotomy
Treatment Methods
Acute
Surgical Decompression
Fasciotomy
Post-op Physical Therapy
Chronic
Conservative methods (4-6 wks)
Physical Therapy
Proper Training techniques
Muscle imbalance
Aquatic Therapy
Pt. Education
Flexibility training
Manual- deep tissue work
NSAIDs and Diuretics
Fasciotomy
90% success rate
Differential Diagnoses
Medial Tibial Stress Syndrome (Shin Splints)
Stress Fracture
Periositis
Tenosynovitis
Arterial entrapment syndromes
Disc Disease
Radiculopathy
McArdles Syndrome (rare)
Questions??
Bibliography
Bouche, R. (n.d.). Chronic Compartment Syndrome. In American Academy of Podiatric Sports
Medicine Articles and Resources. Retrieved June 24, 2008, from American Academy of
Podiatric Sports Medicne Website: http://www.aapsm.org/ chroniccomartment.html
Cluett, J. (2007). Exertional Compartment Syndrome. In Your Guide to Orthopedics. Retrieved
June 24, 2008, from http://orthopedics.about.com
Edmundsson, D., Toolanen, G., & Sojka, P. (2007). Chronic Compartment Syndrome also
Affects Non-Athletic Subjects. Acta Orthopaedica, 78(1), 136-143.
Golden, D. W., Flik, K. R., Turner, D. A., Bach, B. R., Jr., & Sawyer, J. R. (2005, December).
Acute Compartment Syndrome of the Thigh in a High School Soccer Player. The Physician
and Sportsmedicine, 33(12), 19-24.
Reid, D. C. (1992). Exercise-Induced Leg Pain. In Sports Injury Assessment and Rehabilitation
(pp. 269-300). New York: Churchill Livingstone.