Compartment Syndrome

Compartment Syndrome
Sarah Lynn Myers, ATC
Hughston Athletic Training Fellowship

The musculature of the lower leg is contained within four compartments: the anterior compartment, lateral compartment, superficial posterior compartment, and deep posterior compartment. Each compartment contains a variety of muscles, nerves, and blood supply and is held together by a thin tissue called a fascia or sheath. Acute or chronic trauma to any of these compartments can lead to swelling and neurological motor and sensory deficits.

The acute onset usually occurs after blunt trauma to the lower leg, such as being kicked. Severe swelling begins to develop inside the sheaths that surround the compartments of the lower leg. This increase in pressure cuts off nerve and blood supply to the muscles of the affected compartment and could lead to muscle death if not treated immediately.

The chronic onset is seen most often among distance runners or in athletes that play sports requiring a lot of running such as soccer or lacrosse. Pressure inside the fascia increases normally during activity, however, will return to a normal state after activity has stopped. Chronic compartment syndrome occurs when the pressure stays at elevated levels after activity causing pain often confused with medial tibial stress syndrome (“shin splints”) or a stress fracture. The most commonly affected compartment is the anterior compartment followed by the deep posterior compartment.

The signs and symptoms of chronic compartment syndrome are usually bilateral (on both sides of the body). The pain will be achy or sharp. Upon resting, the symptoms will completely subside. If left untreated, neurological involvement may become present in the form of weakness in foot and toe extension, as well as numbness over the top of the foot (for an affected anterior compartment).

Chronic compartment syndrome can be treated initially with RICE (rest, ice, compression, elevation) and NSAIDs (nonsteriodal antiinflammatories, such as ibuprofen). If symptoms persist surgical intervention may be warranted to release the pressure. After surgery the athlete will be allowed to return to light activity within ten days and begin a gradual progression rehabilitation program.

References

Blackman PG: A review of chronic exertional compartment syndrome in the lower leg, Med Sci Sports Exerc 32(3 Suppl):S4, 2000.

Prentice WE. Arnheim’s Principles of Athletic Training. 12th ed. Boston, MA: McGraw Hill; 2006:587-589.


Sarah Myers, ATC, a native of Portsmouth, New Hampshire, is a first year graduate student and recipient of the Hughston Athletic Training Fellowship in Columbus, Georgia. She graduated from The University of Connecticut in May of 2008 with a Bachelor of Science Degree in Athletic Training. While attending UConn, Sarah completed rotations with men’s and women’s track & field, football, and women's volleyball. In addition, she also completed rotations at Loomis-Chaffee School and Trinity College, specifically with men's hockey and men's lacrosse. Sarah served as the Vice President of Student Athletic Training Club at UConn and was involved in the publication of several research articles relating to hydration and athletic participation. She is an active member of the National Athletic Trainer’s Association (NATA). Sarah currently serves as the Head Athletic Trainer at Smiths Station High School, Smiths Station, Alabama.