Anterior Compartment Syndrome???

[dkny5334]

I have been to many doctors in the last 8 years in three different continent figuring out what is wrong with my lower right leg, by all attempts has failed. Every now and then (used to be everyday but has lowered to three-four times a month) the deep area between the "m.peroneus-brevis" and the "m.extensor-digitorum longus" (front, lower part of the leg) has been experiencing a deep itching sensation. To overcome this, I usually need to use my finger to press really hard on one specific area that this sensation always take place, the best methods used to be by getting a friend to punch the area because it was so deep that I could not felt it by touching it. I have done some studies and searching by the internet and think that it could either be an anterior compartment syndrome or something that might have to do with the peronel nerve. Two months ago I tried getting a sport massage and it has help a great deal but because it is busy working season for me now I have no time to go and the sensation is coming back again. I really don't know what is going on because I have done 3 MRI in Bangkok, Berlin and New York but no one seems to be able to tell me what is wrong.

[joyfuljadielady]

hello dr I have a question about compartment syndrome. I am 18 and for the past few years I have had a mild swelling in my leg after exercise or when the weather changes.
Sometimes I have muscle tenderness(no pain) and light muscle spasms here and there. I saw a doctor who gave me a compression sock when I was 12. It never got worse bit never got better. I don't "pit" I only have mild
Indentions when I wear socks. It is not red or hot, please help. If it
Is compartment syndrome I'm very scared because what if my leg is damaged and they have to amputate ? I'm so worried. I just need a professional opinion.

[ChristineR]

Neither Anterior compartment syndrome nor peroneal nerve damage will show up on an MRI.  There are specific tests for these problems that must be done by specialists.  For Anterior compartment syndrome a small amount of saline is injected into the muscle compartment under pressure to measure the compartment pressure.  For nerve damage the electrical resistance is measured across the nerves.  These are unpleasant tests that are not often done unless something is suspected.

Acute compartment syndrome is associated with trauma.  Chronic compartment syndrome is a sports injury that goes away with rest.  However it does not heal; once the sport is resumed the pain comes back.  A few people have such a severe case that even normal walking around is painful.

It does sound like a nerve problem, but anterior compartment syndrome can effect the nerves.  Probably you should see an orthopedist or sports medicine specialist.

[DrNavneetMD]

Hello Dear,

Many cases of Compartment Syndrome are due to trauma. Has there been any history of trauma?
Compartment syndrome is a condition in which the perfusion pressure falls below the tissue pressure in a closed anatomic space, with subsequent compromise of tissue circulation and function. Each muscle or muscle group is enclosed in a compartment bound by relatively rigid walls of bone and fascia. The compartments of the lower leg and the volar forearm are particularly prone to developing elevated compartment pressures.
As many as 45% of all cases of CS are caused by tibial fractures. Other causes include any long-bone fracture, vascular injury, compression in the setting of a crush injury, drug overdose, and a tight cast or dressing
Place the affected limb(s) at the level of the heart. Elevation is contraindicated because it decreases arterial blood flow and narrows the arteriovenous pressure gradient and thus worsens the ischemia.
Reduce compartment pressure by releasing one side of a plaster cast, which can reduce the pressure by 30%; bivalving can produce an additional 35% reduction; and cutting Webril (Kendall Healthcare Products Co) may decrease the compartmental pressure by 10-20%
Mannitol may reduce compartment pressures and lessen reperfusion injury
The definitive surgical therapy for compartment syndrome is emergent fasciotomy (compartment release) with subsequent orthopedic reduction or fracture stabilization and vascular repair, if needed. The goal of decompression is restoration of muscle perfusion within 6 hours. Although several surgical techniques have been described, the double-incision fasciotomy of the lower leg is the most common approach. To minimize soft-tissue injury, especially in the setting of fracture/CS, some surgeons prefer a single-incision approach. Regardless of the approach used, adequate exposure of the entire anterior compartment and, in particular, the peroneal nerve is paramount.

(Refer: http://www.emedicine.com/orthoped/topic596.htm#section~Treatment)

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