Compartment Syndrome ???

Compartment Syndrome ???

Post by Brendan Leit » Wed, 27 Jul 1994 23:02:03


Anyone have experience with Compartment Syndrome ??.  I know that this is
a very uncommon condition, but none the less would like to try to rule
it out as the problem with my calves.

My coach thinks I have a minor chronic Compartment Syndrome, but my physio
and sports doc. do not think that is the problem.  They think it is some
strain, either of some connective tissue, or the soleus muscle. Another
doc. who I spoke to as a friend, not an office visit, also thinks I should
be checked for C.S.

The pain is deep in the calves and runs most of the length of the leg
It is difficult to isolate the pain into one point.  Every time my
physio feels around with it, she finds a different pain spot.  Physio
takes the edge off the pain as do the prescription anti-inflams, but
neither seem to be giving me long term improvement.

I took a week off training and the first two days of rest took the leg
from severe pain to walking, all be-it stiffly, but the next 5 days
offered no improvement.

Cycling is not at all affected by it, does not cause pain when I am doing
it, and I have no loss of strength in my cycling. Strengthening
exercises(eg. calf raises) are not affected and do not cause pain.

It hurts to run, even when I start, and gets worse as I go on.  I went for
an easy 6 miles last night after a week of rest.  The first 3 miles were
somewhat stiff, but not very painfull.  The back 3 miles became quite
uncomfortable.

Having had a couple of stress fractures over the years and tendinitus in the
front of the legs, I can rule those out.  It is also the first injury I have
ever had that affects both legs.

Any injury experiences out there with similar symptoms that were either C.S.
or another problem.  Any/all advice/experiences welcomed.

--
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Compartment Syndrome ???

Post by Mark A. Jenkins, M.D » Thu, 28 Jul 1994 05:49:35

Subject: Compartment Syndrome ???

Date: Tue, 26 Jul 1994 14:02:03 GMT

writes:
Quote:
>Anyone have experience with Compartment Syndrome ??.  I know that this
is
>a very uncommon condition, but none the less would like to try to rule
>it out as the problem with my calves.

>My coach thinks I have a minor chronic Compartment Syndrome, but my
physio
>and sports doc. do not think that is the problem.  They think it is some
>strain, either of some connective tissue, or the soleus muscle. Another
>doc. who I spoke to as a friend, not an office visit, also thinks I
should
>be checked for C.S.

>The pain is deep in the calves and runs most of the length of the leg
>It is difficult to isolate the pain into one point.  Every time my
>physio feels around with it, she finds a different pain spot.  Physio
>takes the edge off the pain as do the prescription anti-inflams, but
>neither seem to be giving me long term improvement.

>I took a week off training and the first two days of rest took the leg
>from severe pain to walking, all be-it stiffly, but the next 5 days
>offered no improvement.

>Cycling is not at all affected by it, does not cause pain when I am doing
>it, and I have no loss of strength in my cycling. Strengthening
>exercises(eg. calf raises) are not affected and do not cause pain.

>It hurts to run, even when I start, and gets worse as I go on.  I went
for
>an easy 6 miles last night after a week of rest.  The first 3 miles were
>somewhat stiff, but not very painfull.  The back 3 miles became quite
>uncomfortable.

>Having had a couple of stress fractures over the years and tendinitus in
the
>front of the legs, I can rule those out.  It is also the first injury I
have
>ever had that affects both legs.

>Any injury experiences out there with similar symptoms that were either
C.S.
>or another problem.  Any/all advice/experiences welcomed.

The compartment syndrome is a condition in which increased pressure
within a muscle compartment causes a decrease in *** supply to the
affected muscles. The so-called compartments are groups of muscles
surrounded by inelastic fascia and thus any swelling of muscles leaves no
room for expansion and *** supply is progressively cut-off.

Compartment syndromes can be acute -- as is seen in high energy trauma
(eg. car accidents) and burns -- or chronic, which is seen as an overuse
injury in an athlete. The acute situation is generally a medical
emergency since rapidly increasing pressure may completely cut off ***
flow and cause necrosis of the affected limb.
The chronic compartment syndrome which occurs as an overuse injury is
most commonly seen in the muscles of the lower extremity but has also
been described in the forearm and the thigh. The mechanism of development
of the chronic compartment syndrome is thought to be,

                OVERUSE
                         |
                         |
                        V
                LOCAL TISSUE SWELLING ---->TIGHT COMPARTMENT
                                ^                               |
                                |                               |
                                |                               V
                                ----------------------DECREASED *** SUPPLY

A viscious cycle can become established.
What the athlete experiences is pain that begins during activity that
progressively worsens and ceases during rest. This is distinct from the
pain of other overuse injuries. The pain associated with tendinitis
usually begins as soon as exercise is started, lessens with continued
exercise -- as the muscles and tendons warm-up -- and then returns after
exercise is stopped.
To accurately diagnose the chronic compartment syndrome, pressure testing
within a muscle compartment can be performed. A flexible plastic catheter
is inserted through a small slit in the skin into a muscle compartment.
The catheter is hooked up to a pressure transducer and the pressure
within  the compartment is measured. The athlete then engages in the pain
inducing activity (eg. running on a treadmill) while a continual
recording of compartment pressure is made. Reproduction of painful
symptoms associated with pressures above a certain value confirms the
diagnosis.
Treatment consists of
        a) correction of any biomechanical abnormalities
        b) soft tissue therapy
        and in severe cases not responding to the above, surgery.

Of interest to readers of this newsgroup is that running tends to cause
higher lower extremity intracompartmental pressures than does cycling.

I hope this helps and wish you a speedy recovery.

                                                        Mark A. Jenkins, M.D.
                                                        specializing in triathlons,
                                                        internal medicine,
                                                        and sports medicine.