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compartment syndrome

Etiology: - blunt trauma, crush injury, motor vehicle accident - tibial fracture [7] - burns - chronic microtrauma - excessive running - obesity - prolonged standing Pathology: 1) anterior compartment is most frequently involved 2) compartmental pressures during weight-bearing exercise may be high enough to cause neurapraxia of the peroneal nerve Clinical manifestations: 1) pain after exercise 2) foot drop 3) sensory loss 4) peripheral pulses may or may not be palpable 5) lower leg compartment syndrome: - pain with passive stretching of foot or toes [6] * images (forearm) [4] Special laboratory: - measurement of compartment pressures (after exercise) Radiology: - computed tomography (CT) or magnetic resonance imaging (MRI)* * acute compartment syndrome requires urgent surgical evaluation Differential diagnosis: - peripheral arterial disease (PAD) - exercise causes pain earlier in PAD than in chronic exertional compartment syndrome (CECS), (median, 4 vs. 15 minutes) [5] - pain alleviated almost immediately with PAD, but lingers with CECS [5] - necrotizing fasciitis - gas gangrene Complications: - edema & increased pressure from damage of trauma may result in myonecrosis & permanent dysfunction [6] Management: 1) acute compartment syndrome requires urgent surgical evaluation [6] 2) surgery: limited fasciotomy (incision < 2 cm) 3) chronic (not acute) a) rest b) adjustment of training c) patients generally return to full activity within 1 month

Related

leg pain

Specific

abdominal compartment syndrome chronic exertional compartment syndrome (CECS) orbital compartment syndrome

General

musculoskeletal disease/disorder syndrome

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
  2. Kosir R, Moore FA, Selby JH, Cocanour CS, Kozar RA, Gonzalez EA, Todd SR. Acute lower extremity compartment syndrome (ALECS) screening protocol in critically ill trauma patients. J Trauma. 2007 Aug;63(2):268-75. PMID: 17693823
  3. MedicineNet: Compartment Syndrome http://www.medicinenet.com/compartment_syndrome/article.htm
  4. Egan AF, Cahill KC Compartment Syndrome. N Engl J Med 2017; 377:1877. November 9, 2017 PMID: 29117495 http://www.nejm.org/doi/full/10.1056/NEJMicm1701729
  5. de Bruijn JA et al. Chronic exertional compartment syndrome in the differential diagnosis of peripheral artery disease in older patients with exercise-induced lower limb pain. J Vasc Surg 2021 Jun; 73:2114. https://www.jvascsurg.org/article/S0741-5214(20)32498-8/fulltext
  6. NEJM Knowledge+ Rheumatology
  7. Barnes DK, Randhawa SDS, Fitzpatrick EP. Under Pressure: Delayed Diagnosis of Compartment Syndrome after Lower Leg Fracture. PSNet. April 24, 2024 https://psnet.ahrq.gov/web-mm/under-pressure-delayed-diagnosis-compartment-syndrome-after-lower-leg-fracture