compartment syndrome

Etiology

• blunt trauma, crush injury, motor vehicle accident
• burns
• chronic microtrauma
  • excessive running
  • obesity
  • prolonged standing

Pathology

• anterior compartment is most frequently involved
• compartmental pressures during weight-bearing exercise may be high enough to cause neurapraxia of the peroneal nerve

Clinical manifestations

• pain after exercise
• foot drop
• sensory loss
• peripheral pulses may or may not be palpable
• lower leg compartment syndrome:
  • pain with passive stretching of foot or toes

* images (forearm)

Diagnostic procedures

• measurement of compartment pressures (after exercise)

Radiology

• computed tomography (CT) or magnetic resonance imaging (MRI)*

* acute compartment syndrome requires urgent surgical evaluation

Complications

• edema & increased pressure from damage of trauma may result in myonecrosis & permanent dysfunction

Differential diagnosis

• peripheral arterial disease (PAD)
  • exercise causes pain earlier in PAD than in chronic exertional compartment syndrome (CECS), (median, 4 vs. 15 minutes)
  • pain alleviated almost immediately with PAD, but lingers with CECS
• necrotizing fasciitis
• gas gangrene

Management

• acute compartment syndrome requires urgent surgical evaluation
• surgery: limited fasciotomy (incision < 2 cm)
• chronic (not acute)
  • rest
  • adjustment of training
  • patients generally return to full activity within 1 month

More general terms

• musculoskeletal disease/disorder
• syndrome

More specific terms

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

Additional terms

• leg pain