- Military
- Female gender
- Diabetes Mellitus
- Young athletes
- Most common associated sports
- Soccer
- Running
- Lacrosse or Field Hockey
- Predisposing factors
- Fascial defects and Herniation may contribute in more than one third of cases
- However, poor fascial compliance does not appear to be a contributing factor
- Increased intracompartmental pressure associated with Muscle overuse
- Muscle volume increases with Exercise as much as 20%
- Repetitive use results in Muscle hypertrophy and increased local Blood Volume
- Increased pressure results
- Decreased perfusion (arteriole compression, capillary Occlusion) with secondary ischemic pain
- Microvascular nutrient exchange
- Nerve compression
- General
- Characteristics
- Aching, burning or cramping pain
- Modifying Factors
- Exercise-induced pain and swelling relieved with rest
- Associated Symptoms
- Numbness
- Paresthesias
- Muscle Weakness
- Distribution
- Lower Leg (95% of cases)
- Anterior compartment (>42%) and Lateral Compartment (35%) are most often affected
- Foot "slap" while Running
- Anterior compartment dorsiflexor weakness
- First interdigital webspace numbness
- Anterior compartment deep peroneal nerve compression
- Lateral foot eversion weakness
- Lateral compartment Muscle Weakness
- Lateral leg and dorsal foot numbness
- Lateral compartment superficial peroneal nerve compression
- Forearm
- Thigh
- Gluteal region
- Lower Leg (95% of cases)
- Acute Exertional Compartment Syndrome
- See Compartment Syndrome
- Similar presentation as in Compartment Syndrome
- Chronic Exertional Compartment Syndrome
- Gradual aching extremity pain
- Bilateral extremity involvement in more than 75% of cases
- Sensation of fullness over involved compartment
- Pain begins predictably after Exercise start (e.g. exertional Leg Pain)
- Fixed time interval into Exercise routine or
- Specific intensity level
- Pain relieved with 20 minutes of rest
- Pain recurs on resuming Exercise and progresses in severity overtime
- Over time, symptoms occur with decreased amounts of Exercise with longer periods of pain
- Perform exam immediately after Exercise
- See Compartment Syndrome
- Extremity neurovascular exam
- Musculoskeletal Exam for Muscle, tendon, bone injury
- See Intracompartmental Pressure Monitor
- Technique (typically in sports medicine or orthopedic clinic)
- Patient runs on treadmill or track to maximal symptoms
- Intracompartmental Pressure is measured immediately
-
Intracompartmental Pressure Monitor Criteria (Pedowitz Criteria)
- Readings are only valid if Exercise reproduces symptoms
- Post-Exercise pressures are compared to pre-Exercise pressures
- Pre-Exercise resting pressure >=15 mmHg
- Post-Exercise pressure at 1 minute >= 30 mmHg
- Post-Exercise pressure at 5 minutes >= 20 mmHg
- Post-Exercise elevated pressure despite 15 minutes rest
- Stress Fracture
- Periostitis
- Deep Vein Thrombosis
- Posterior Tarsal Tunnel Syndrome
- Lumbar Radiculopathy
- Bone lesion or tumor
- Popliteal artery entrapment syndrome
-
Medial Tibial Stress Syndrome
- Most common cause of exertional Leg Pain
- Extremity XRay
- Venous Ultrasound for DVT
- Triple phase bone scan
- Stress Fracture: Transverse linear pattern
- Shin Splint: Longitudinal linear uptake
- Diagnosis is often delayed (median time to diagnosis 28 months)
- Acute Exertional Compartment Syndrome
- See Compartment Syndrome
- Emergent evaluation and management as Compartment Syndrome
- Consideration for emergent Fasciotomy (within first 4 hours is critical)
- Chronic Exertional Compartment Syndrome
- Initial symptomatic management
- Avoid provocative activies
- Oral Analgesics
- Referral to sports medicine or orthopedics
- Modify extrinsic factors
- Training surface
- Athletic shoe
- Training intensity
- Modify Intrinsic Factors (e.g. hindfoot pronation)
- Physical therapy
- Ice
- Massage
- Strengthening Exercises
- StretchingExercises
- Orthotics
- Surgery for recurrent symptoms over 3 months
- Compartment-Release Fasciotomy (single or multi-compartment)
- Return to full activity within 3 months is typical
- Postoperative rehabilitation
- Compartment-Release Fasciotomy (single or multi-compartment)
- Blythe, Gray and Delasobera (2018) Crit Dec Emerg Med 32(7):3-9
- Edwards (1996) Physician Sportsmed 24(4):31-46
- Abramowitz (1994) Orthop Rev 23(3):219-25 [PubMed]
- Detmer (1985) Am J Sports Med 13(3): 162-70 [PubMed]