Exertional Compartment Syndrome- Yoho

Question 1

pathophysiology of exertional compartment syndrome

Answer 1

• 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

Question 2

normal resting compartment pressure

Answer 2

0-8 mmHg

Question 3

s/s chronic compartment syndrome

Answer 3

• 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

Question 4

compartment pressure criteria normal is 0-8 mm Hg at rest

Answer 4

pre-exercise or resting pressure: = or > 15 mm Hgone minute post-exercise pressure: = or > 30 mm Hgfive minute post-exercise pressure: = or > 20 mm Hgthirty minute post-exercise pressure: slightly > pre-exercise pressure

Question 5

conservative tx

Answer 5

• stop athletic activity 2-3 weeks- graduated return/change to non-provocative athletic activity

Question 6

surgical tx

Answer 6

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

Question 7

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

Answer 7

• Periostitis/Soleus Syndrome/Posterior medial shin splints- Chronic compartment syndrome- Stress fracture- Myositis

Question 8

etiology posterior medial shin splints/periostitis

Answer 8

• overuse injury- biomechanical/hyperpronation- combination- progression of myositis

Question 9

s/s posterior medial shin splints

Answer 9

• 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

Question 10

pathophysiology of posterior medial shin splints/ periostitis

Answer 10

• 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*

Question 11

what rules out taking pressure measurements?

Answer 11

no neurological symptoms- order a Tc99 to look for patterns of uptake if you suspect posterior medial shin splints with a normal xray

Question 12

tx posterior medial shin splints

Answer 12

• reduction in activity- RICE- NSAIDS (analgesic)- address biomechanical issuesif unresponsive … surgical release of fascia attachment into posterior medial aspect of tibia

Question 13

s/s stress fracture

Answer 13

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

Question 14

pathophysiology of stress fractures

Answer 14

• 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

Question 15

what differentials are included in anterior tibial stress syndrome?

Answer 15

• myositis- anterior tibial shin splints- stress fracture- anterior compartment syndrome

Question 16

s/s ATSS

Answer 16

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

Question 17

pain with uphill running

Answer 17

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

Question 18

pain with downhill running

Answer 18

TENSION anterior tibial shin splintsFrontal plane imbalanceTight tibialis anteriorExcessive pronationPain with downhill runningstretch anterior tibialis, address pronation