What is Anterior Compartment Syndrome?
This is a type of ailment of the lower leg caused by swelling in the shin area – lower leg in the front. This swelling or inflammation compresses as well as diminishes the nerve and blood flowing to the feet and lower leg. This arises when there is a muscle which has become too large for the sheath which surrounds the muscle. These syndromes of the compartment may be either chronic or acute. This is also referred to as anterior shin splints.
Signs and symptoms occurring with this syndrome include:
- A pain in the muscle that is sharp and on the outside of the lower part of the leg, normally caused by a direct blow
- Deep, tingling or cramping in the shin that is worse when exercising and goes away with rest
- While trying to bring the foot upwards counter to resistance feeling weakness
- Tenderness and swelling over the tibialis anterior muscle
- Pain when the toes and foot are pulled downwards – called foot drop
- Feet and toes can be cold
- Swelling that is excessive causes the skin to be hot, glossy and stretched
Physicians who specialize in sport medicine also referred to the symptoms as the “Five (5) Ps of Anterior Compartment Syndrome”. These p’s stand for:
- Paralysis – if not treated
Tenderness and tightness over the total middle of the tibialis anterior which does not react to pain medications and elevation may be early suggestions or signs of this syndrome.
Anterior Compartment Syndrome Causes
This compartment syndrome can happen as a result of:
- A tear of the muscle which causes bleeding as well as swelling
- An impact to the lower leg that causes bleeding within the compartment and causes swelling
- Over use injury that also causes swelling
An objective and subjective thorough exam from a physiotherapist is normally enough to diagnose any compartment syndrome. Pressure testing inside the compartment may be used for confirmation of the diagnosis and also to identify the muscle compartment that is involved. Techniques such as bone scans, X-rays, MRI or CT scan might in some cases be used in order to assist the diagnosis or to exclude the possibility of other problems.
Acute compartment syndrome happens from distress to bone or muscle in compartment which leads to bleeding inside the compartment. The more build-up of blood with nowhere to go, the pressure increases at a fairly rapid rate – in some cases to a high level that can cause serious damage to the blood vessels and nerves.
Chronic compartment syndrome is normally from overuse. The muscle becomes inflamed and swells overtime and with rest will return to normal. But this causes pressures that are at times high and can cause damage to the blood vessel and nerve tissue.
Anterior Compartment Syndrome Treatment
The majority of cases of this syndrome usually get well by themselves with suitable physiotherapy. This does require careful examination by the physiotherapist to decide what factors contributed to this condition happening. Soft tissue stretches and massage to help tightness in the muscle can play the biggest role in treatment, along with assessment biomechanically as well as addressing any posture of the foot issues.
The rate of success for treatment with anterior compartment syndrome is normally dependent on compliance by the injured person. One of the major parts of the treatment is for the individual to rests from any activity that causes the pain to increase until they are free of symptoms. Once the individual is pain free, a slow return to activities can then begin only if there is no increase in symptoms.
To ignore symptoms or adopt the attitude of ‘no pain, no gain’ will lead quickly to the problem becoming chronic. Appropriate, immediate treatment for individuals with this problem is critical for recovery that is speedy. Once this condition becomes chronic, healing will slow down considerably and can cause a big increase in times of recovery.
There are activities that place minimal stress on the lower leg that can be engaged in to maintain fitness. These can include:
- Swimming in a pool
- Hydrotherapy exercises
- Upper body weight – sitting and lying down
- In some cases cycling
Deep tissue massage – this is a very effective method for treating compartment syndrome and needs to be part of any rehabilitation program.
Strengthening and flexibility exercises – individuals should not do too much – as this should be pain free to make certain that there is an optimal outcome.
Gradual return to normal activities - final stages of treatment when pain has been controlled and other contributing factors have been addressed, should proceed gradually.
Anterior Compartment Syndrome Surgery
When conservative therapy fails, surgery is then indicated to reduce any pressure within the muscle compartment.
This surgery consists of fasciotomy which is an incision that is made down the entire length of the sheath of the muscle so as to permit the pressure of that muscle to be unconfined.
This can be accomplished either by a one (1) or two (2) incision procedure. The benefit to the single incision is that only one (1) cut is made into the leg, the drawback is that it is more problematic to make certain the compartment is completely released. The drawback of the two (2) incision method is more scarring on the leg.
The single or one incision procedure:
- A single or one incision five (5) to six (6) cm is made down the middle and one (1) cm back from the tibia bone.
- The fascia covering the superficial compartment is cut down and up the leg
- Retractors are then used to uncover the muscle referred to as tibialis posterior and the fascia is cut down its length.
- Immediately a compression bandage is applied. But a drain is rarely needed.
- The patient might need to use crutches for several days.
- Active and passive mobility exercises needs to begin immediately
- Once the wound heals, walking and cycling are encouraged.
- At two (2) weeks it will be probable to jog although no running for at least six (6) weeks.
- It normally takes three (3) months before recovery is complete.
Most complications are usually due to nerve or blood vessel damage. A damaged nerve can cause permanent numbness as well as possibly a painful neuroma.
Signs of “deep compartment syndrome” can reoccur if a compartment is not released correctly and becomes scarred thru mobilization that is poor after surgery.
Nerve irritation that is persistent can happen because of the nerve irritation against the incised fascia. Certain individuals might have mild weakness in the lower part of the leg.
Anterior Compartment Syndrome Prevention
Prevention of these types of syndromes includes avoiding the activities and conditions which could lead to increasing any pressure inside the compartment. Some of the procedures below will assist with prevention:
Warm the muscle properly before use
- Warm packs and heat retaining coverage
- Activities that cause pain should be avoided
- Slow increase of duration and intensity to build up conditioning
- Stretching the muscles as this will help relieve pressure
- Get adequate rest between concentrated workouts or intense training sessions.
- Avoid actions that can cause direct injury to any of the bones or muscles in the compartment.