Dull severe pain in lower extremity

3. Dull severe pain in lower extremity

5. Exercise Induced Compartment syndrome Exertional Compartment Syndrome

6. Compartment syndrome • Compression of nerves, blood vessles and muscle inside a closed space • Leads to tissue death from lack of oxygenation • Involves the forearm and lower leg • Divided into acute, subacute and chronic

7. Chronic type • Repetitive use of muscles such as a cyclists

8. What are the 5 P’s?

9. 5 or 6 P’s • Pain • Paresthesia • Pallor • Paralysis pulselessness • Polar/poikilthermia (failure to thermoregulate)

10. Symptoms • Pain with activity and relieved with rest • Tingling or numbness in the leg or foot due to the lack of blood flow to the nerves • Area over the muscles feel very tight

11. Pain • Reported early • Severe, deep constant and poorly localize and out od proportion wit the injury • Pain is made worse by stretching the muscle group within the compartment • Pain is not relieved by morphine

12. Causes • Tibial and forearm fractures • Hemorrhage • Drug injections • Casts • Crush injuries • Burns

13. DDX • Uncommon • Stress syndrome - shin splints • Stress fracture

14. Causes • Pressure builds up in muscle • Enclose in a tight fascia • Blood flow increases in muscles and size of muscles increases • Fascia becomes too tight • Constricts the muscle during activity

15. As muscle expands and becomes contracted by the fascia, blood flow to the muscle is interrupted and ischemia occurs • Like a heart attack pain develops

17. Name the lower leg compartments?

18. Lower leg Compartments • Anterior • Lateral • Deep posterior • Superficial posterior

19. Anterior Compartment syndrome • Anterior compartment is most often involved • Pain with activity completely subsides after 15 minutes of rest • Exam: weakness of toe extension and pain on passive toe flexion • Diminished sensation in the first web space

21. Posterior Compartment SyndromeTibialis Posterior Muscle compartment • Weakness of toe flexion and ankle inversion • Pain on passive toe extension • Diminished sensation over the sole of the foot

22. Lateral Compartment syndrome • Signs and syndromes are similar to anterior tibial compartment syndrome but the peroneus longus and brevis muscles are involved • Pain is usually absent anteriorly but the muscles of the anterior compartment are paralyzed from ischemia of the deep peroneal nerve as it passes thru

24. Diagnoses • Measure the pressure within the muscle • Pressure is made at rest • Patient does some activity until there is pain • Usually the pain changes is small but with exercise induce compartmental syndrome symptoms are present after exercise

25. Pressures • Normal pressures at rest are between 0 and 4 mm Hg (some say <11 mm is normal) • Post-exercise reading of greater than 35 mm Hg is highly indicative of compartment syndrome and great than 40 mmHg is diagnostic

27. Treatment • Rest • Surgery is needed – fasciotomy • Major risk is cutting the nerve

28. Technique • SubQfasciotomy • 2 vertical incisions (one distal and one proximal) • If a fascia hernia is present incorporate the fascia defect into the fasciotomy incision

31. Post-op • AROM is not restricted postoperatively • Once incisions are healed patient can begin progressive activities as tolerated • Return to full activities in 3 to 4 weeks

32. Complications • Necrosis of tissue in that compartment • Rhabdomyolysis and kidney failure • Death

33. Endoscopic Compartment release • Safe technique to use for chronic

34. Abdominal Compartment syndrome

35. How do you measure intra-abdominal pressure?