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Anterior Compartment Syndrome. By Marie and Molly. History. 20 year old female soccer player Midfield Position During one of the last practice sessions of the season was kicked in the shin by another player Athlete was not wearing shin guards. Signs and Symptoms.
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Anterior Compartment Syndrome By Marie and Molly
History • 20 year old female soccer player • Midfield Position • During one of the last practice sessions of the season was kicked in the shin by another player • Athlete was not wearing shin guards
Signs and Symptoms • Pt. c/o pn w/passive plantar flexion • Pn along ant. Aspect of lower leg • Palpation reveals hardness and tension w/soft tissue • Shiny or pallor skin • Distal pulse diminished • Numbness and tingling radiating to toes
Diagnosis • Pt. has Anterior Compartment Syndrome • What is it? • There are 4 compartments in the lower leg • Each compartment holds fascia and muscle • Pressure becomes too great and there is no room for expansion • Vascular structures and neural structures can be damaged • Anterior compartment most commonly injured
Treatment • Surgery must be performed • A fasciotomy is performed to release pressure in the compartment • 95% success rate
Treatment • Muscles invloved • Tibiallis Ant. • Ext. digitorum lungus • Ext. hallicus lungus
Surgery Fascial release Cut distally injection Close up of cross section Release of peroneal nerve
Treatment Post Op • Must be place on crutches w/non-weight bearing for 7-10 days • Friction massage by incision for soft-tissue mobility • Gait training • NSAIDS
Goals for Post-Op • Full ROM • Biking/Swimming 2-4 weeks • Swimming when wound heals • Jogging at 4-6 weeks • Sports participation 6-8 weeks • Athlete should be able to run 2-3 miles pn free before returning to play
Modalities • Milk Massage • Myofascial release • Release scar tissue • Ice Bag/slush bucket • Heat • Start 3rd week
Week 1 • Non-weight bearing • Check wound dressing daily
Week 2 • Partial weight-bearing • 2 point gait • Isometric exercises • Inversion • Eversion • Planter flexion • Dorsiflexion • Toe Exercises • Towel rolls
Week 2 cont. • Alphabet • Weight-scale exercise • Stretching • Gastroc stretch • Soleus stretch • Achilles stretch • Dorsiflex stretch
Week 3/4 • Arm Bike/Elliptical • Gait training • POOL • Single leg stance • Grapevine • Step ups • Gastro/soleus stretch • Heel raises
Week 3/4 Cont. • Ankle Walking • Double knee bend • Seated knee extension • Team core work-out
Week 5/6 • Underwater treadmill • BAPS board • Two legs • Closed kinetic chain • 4 Lunges • Squats both legs • Leg presses
Week 5/6 • Terminal knee ext. • Heel raises • Lower leg and foot stretches • Rubber Tubing • Inversion/eversion • Plantar/dorsiflexion
Week 7/8 • Warm up walking on treadmill • Stair climber • Treadmill jogging ½ mile to 1 mile • Lower leg stretches • BAPS board • One leg • 4 Lunges w/tubing • Leg press- • More weight
Week 7/8 cont. • Heel raises • Tubing exercises w/increase resistances • Lunges w/tubing
Week 9/10 • Running on the field • Swimming • Box jumping • Dot drills • Long/short passing • Ball Juggling • Backwards running w/ball kicking • Z-lines w/ball • Corner Kick drills
Week 9/10 • During last week they must pass functional tests before moving to functional exercises • Must be pain free • Functional exercise • Scrimmage
Practice • Return to play w/shin guards • Athlete may participate in: • Upper Extremity Weight Lifting • Practice drills as tolerated w/lower ext. • Any upper extremity drills • Core work outs
Considerations • Watch for: • Increase swelling • Increase pain • Numbness or tingling • If any apply, modify the rehab • Everything is as tolerated • May need to continue rehab longer than expected