The compartment syndrome

Question:

>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.

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.

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. It is the first injury I have ever had that affects both legs.

Medical reply

The compartment syndrome is a condition in which increased pressure within a muscle compartment causes a decrease in blood 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 blood 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 blood 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 ----> LOCAL TISSUE SWELLING ---->TIGHT COMPARTMENT

TIGHT COMPARTMENT---->DECREASED BLOOD SUPPLY----->MORE TISSUE SWELLING

A viscious cycle can become established.

What the athlete experiences is pain that begins during activity, progressively worsens, and then 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
  1. correction of any biomechanical abnormalities
  2. soft tissue therapy
  3. 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.



jenky@rice.edu