CHRONIC COMPARTMENT SYNDROME OF THE LEG

The article defines acute and chronic compartmental syndrome of the leg and discusses the incidence, pathophysiology, aetiology and signs and symptoms of chronic compartmental syndrome. The value of specific investigations and of surgical or conservative treatment are discussed.

BY DR NAT PADHIAR, MSC PHD FCPODS

INTRODUCTION Pain in the lower leg brought on by exercise but relieved by variable periods of rest is a common complaint among athletes, particularly after an unaccustomed increase in activity or at the start of the season. The term “shin splints” or “fresher’s leg” is often used by athletes, trainers and doctors to describe the condition. These are non-specific terms and, although the history and symptoms have long been recognised, the term itself has never been defined restrictively. In 1966 the American Medical Association (AMA) published The Standard Nomenclature of Athletic Injuries (1). This was prepared by a subcommittee of the Committee on Medical Aspects of Sports and after extensive canvassing of the opinions of physicians, trainers, physical educators and other interested parties in sports medicine. They defined shin splints as “pain and discomfort in the leg from repetitive running on hard surfaces or forcible, excessive use of the foot flexors” and stated that “diagnosis should be limited to musculotendinous inflammations, excluding fracture or ischaemic disorders”. There was a mixed response

to this definition, but in the main it was criticised widely. If nothing else, however, the AMA definition created enough interest in the subject for each author to express a preference for their own classification. There is now a broad agreement that most exercise-induced leg pain falls into one of the following

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categories: n Pain of bony origin, eg. focal stress fracture and diffuse microfracture of stress reaction n Pain of osteofascial origin usually along the medial border of the tibia, eg. periostitis (often referred to as medial tibial stress syndrome; MTSS) n Pain of muscular origin, eg. exertional compartment syndrome (acute and chronic); the chronic form is commonly referred to as chronic compartment syndrome (CCS) n Pain due to compression of a nerve, eg. compression of the superficial peroneal or tibialis posterior nerve n Pain due to regional compression of a nerve at spinal and pelvis level, eg. radicular leg pain n Pain due to temporary vascular compromise, eg. popliteal artery entrapment syndrome.

COMPARTMENT SYNDROME Compartment syndrome is defined as a condition in which the circulation and function of tissues within a closed space are compromised by increased pressure within that space (2). The term “compartment syndrome” usually refers to localised myoneural ischaemia and occurs in acute and chronic forms with regards to aetiology, time sequence and reversibility.

Acute compartment syndrome Richard Volkmann first described the ischaemic contracture that followed the application of tight dressings: “Sciatic paralyses and contractures which have

sportEX medicine 2009;40(Apr):16-22