56: Exertional Compartment Syndrome - Yoho Flashcards

1
Q

pathophysiology of exertional compartment syndrome

A
  • Increased tissue pressure from decreased fascial envelop or increase in volume of the compartment.
  • Increased compartmental pressure leads to increased venous pressure and reduced local arterio-venous
    gradient
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2
Q

normal resting compartment pressure

A

0-8 mmHg

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3
Q

s/s chronic compartment syndrome

A
  • pain with activity resolves with rest, however, variable
  • duration symptoms persist after activity is stopped
  • sensation of cramping or tightness with athletic activity
  • complaints of weakness of extremity with athletic activity
  • neurological abnormalities during and for a period after
  • activity tightness of tautness on palpation of the involved compartment
  • 50% of patients with anterior chronic compartment
  • syndrome present with fascial defects
  • able to recreate symptoms in office setting with exercise
  • biomechanical faults/imbalances
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4
Q

compartment pressure criteria

normal is 0-8 mm Hg at rest

A

pre-exercise or resting pressure: = or > 15 mm Hg

one minute post-exercise pressure: = or > 30 mm Hg

five minute post-exercise pressure: = or > 20 mm Hg

thirty minute post-exercise pressure: slightly > pre-exercise pressure

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5
Q

conservative tx

A
  • stop athletic activity 2-3 weeks

- graduated return/change to non-provocative athletic activity

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6
Q

surgical tx

A
  • decompression of involved compartment
  • crutch assistance ambulation first 2 weeks
  • alternative athletic activity
  • no running for four week
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7
Q

ddx for medial tibial stress syndrome (not a diagnosis itself)

A
  • Periostitis/Soleus Syndrome/Posterior medial shin splints
  • Chronic compartment syndrome
  • Stress fracture
  • Myositis
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8
Q

etiology posterior medial shin splints/periostitis

A
  • overuse injury
  • biomechanical/hyperpronation
  • combination
  • progression of myositis
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9
Q

s/s posterior medial shin splints

A
  • Pain induced by activity, relieved by rest
  • Dull ache to intense pain
  • Tenderness distal posterior medial tibia
  • Localized longitudinal fusiform firm swelling
  • Lack of neurological or vascular abnormalities
  • Pronated foot
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10
Q

pathophysiology of posterior medial shin splints/ periostitis

A
  • Repetitive impact loading with hyperpronation results in
    tension along the investing fascia of the distal fibers of the soleus muscle.
  • Continuous stretching of these structures results in a periostitis.
  • There is controversy regarding the role of the tibialis posterior muscle. Its anatomic proximal attachment is posterior lateral rather than posterior medial aspect of the tibia * this is why we call it soleus syndrome instead*
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11
Q

what rules out taking pressure measurements?

A

no neurological symptoms

- order a Tc99 to look for patterns of uptake if you suspect posterior medial shin splints with a normal xray

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12
Q

tx posterior medial shin splints

A
  • reduction in activity
  • RICE
  • NSAIDS (analgesic)
  • address biomechanical issues

if unresponsive … surgical release of fascia attachment into posterior medial aspect of tibia

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13
Q

s/s stress fracture

A
  • Localized pain and tenderness
  • Swelling
  • Palpable firmness related to cortical
  • Hypertrophy or periosteal new bone formation
  • Pain with activity
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14
Q

pathophysiology of stress fractures

A
  • Repetitive compression and impact loading forces resulting in decreased cellular response and inadequate or insufficient remodeling of stressed
  • Fatigue and failure of osseous homeostatic mechanisms
  • Decreased electrical activity as determined by the piezoelectric phenomenon
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15
Q

what differentials are included in anterior tibial stress syndrome?

A
  • myositis
  • anterior tibial shin splints
  • stress fracture
  • anterior compartment syndrome
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16
Q

s/s ATSS

A
  • Pain along lateral tibial crest
  • Localized tenderness and swelling
  • Pain with activity
  • Post-static dyskinesia
17
Q

pain with uphill running

A

anterior tibial shin splints FATIGUE
( tight posterior m. group/ weak anterior group due to sagittal plane imbalance)

tx with heel lift/strengthen ant tib, decreased hill running, stretch gastroc

18
Q

pain with downhill running

A

TENSION anterior tibial shin splints

Frontal plane imbalance
Tight tibialis anterior
Excessive pronation
Pain with downhill running

stretch anterior tibialis, address pronation