Chronic exertional compartment syndrome cecs is a painful condition of the lower leg that affects many runners and other athletes involved in repetitive impact activities. Rehabilitation guidelines following compartment syndrome. A recurrent tightening or tense sensation and aching in anatomically defined. If you can prepare, your surgeon will tell you what to do. The literature on surgical management of cecs is mixed, and overall.
The preferred technique in trauma for fasciotomy of the below the knee cs is the two incision four compartment fasciotomy. Lower extremity compartment syndrome is a devastating complication if not rapidly diagnosed and properly managed. The most sensitive clinical symptom of compartment syndrome is severe pain. Lower leg fasciotomy may be performed with a single lateral incision with. Late findings of acs can lead to limb amputation, contractures, paralysis, multiorgan failure, and death. Decompression fasciotomy of the lower leg clinical pain. The main causes are exercise induced compartment syndrome, periostitis of the tibia, stress fracture, venous diseases, obliterative arterial diseases, and shin splints. Single and dualincision fasciotomy of the lower leg. Despite the small skin incisions the fascia can be completely released from just below the knee to just above the ankle. If an athlete or a soldier wants to continue training, there is no proven effective nonoperative treatment, and fasciotomy of 1 or more of the lower leg muscle compartments is usually recommended.
It is an overuse condition mostly in young athletic patients and causes exerciserelated pain. Single and dual incision fasciotomy of the lower leg youtube. Effect of lower extremity fasciotomy length on intracompartmental pressure in an animal model of compartment syndrome. The pain associated with this condition is thought to be abnormal pressure. Fasciotomy was beneficial in 71% of patients with dpcecs in the lower leg. When the underlying muscle is injured, due to infection or blood clot, it will swell. Compartment syndrome can be either acute or chronic. Singleincision 4compartment fasciotomy of the lower leg. Whatever the technique uni or multilateral approaches, prompt fasciotomy represents the definitive way of treatment of this pathology. To our knowledge this is the first study to report an objective measure of the functional outcome following primary fasciotomy for the treatment of cecs.
Fasciotomy for lateral lowerleg chronic exertional. The most common site for cecs in the lower limbs is the anterior leg compartment. Ebraheim, md, saaid siddiqui, md, and craig raberding, md summary. Although less common, acute compartment syndrome can occur in the thigh, buttock, and foot 37. Symptoms in both legs occur in 8595% of those affected. Acute limb compartment syndromes oxford academic journals. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. Fasciotomy is the treatment of choice for athletes who would like to maintain the same level of activity. He had several episodes of lower leg pain, which sustained around 1530 minutes during rest.
Specific changes in the program will be made by the. Compartment syndrome of the lower leg or foot, a severe complication with a low incidence, is mostly caused by highenergy deceleration trauma. This protocol will focus on the open fasciotomy for the lower leg, which involves 12 incisions approximately 610mm in length on the skin. Open 4compartment fasciotomy for chronic exertional. Exertional compartment syndrome occurs when the muscles expand during exercise and the. Although a majority of surgeons tend to use a 2incision approach to 4compartment. Keywords compartment syndrome lower extremity fasciotomy chronic leg pain introduction chronic exertional compartment syndrome cecs is. Rehabilitation guidelines following compartment syndrome release with open fasciotomy 333 38th st. The duration of the syndrome varied from 1 month to 10 years. Early recognition of cs is mandatory in avoiding local complications and major tissue loss. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level. Single and dualincision fasciotomy of the lower leg ncbi. The classic symptoms of compartment syndrome can be deceiving as they occur late. Sensory territory is confined to webspace between 1st and 2nd toes and activates dorsiflexion superficial peroneal nerve runs along lateral compartment and supplies dorsum of the foot except 1st webspace posterior tibial nerve is within.
Achieving the criteria of each phase should be emphasized more than the approximate duration. Lower leg fasciotomy may be performed with a single lateral incision with or without. Chronic exertional compartment syndrome of the deep posterior. Fasciotomy is often done as emergency surgery because pressure builds up suddenly. A singleincision fasciotomy for compartment syndrome of the. Exercise induced compartment syndrome is the least common. The competent trauma surgeon must be familiar with lower extremity fasciotomy. A lower leg cecs most commonly occurs in the anterior muscle compartment. Patients with additional surgery will progress at different rates. In addition, patients who suffer from chronic compartment lower extremity syndromes may also benefit from fasciotomy. August, 2005 acute compartment syndrome of the limb. The patients main complaint was pain when walking located in the medial ventral muscle compartment of the lower leg. Compartment syndrome of the lower leg is not only described following trauma, arterial obstruction, lithotomy position 35, 60, and fracture table positioning, but also the clinical entity of a chronic exertional compartment syndrome is described.
Cecs has been reported in the forearm, thigh, hand and foot. Compartment syndrome after abdominal aortic aneurysm repai. Compartment syndrome of the leg is an orthopaedic emergency and can be treated with single or dualincision fasciotomy, allowing for necessary. Lower leg fasciotomy may be performed with a single lateral incision with or without fibulectomy, or by a double incision technique, with most surgeons preferring the later.
Fasciotomy for lower leg deep posterior chronic exertional compartment syndrome. Chronic exertional compartment syndrome cecs is a signi. Compartment syndrome is a condition that occurs when injury causes generalized painful swelling and increased pressure within a compartment to the point that blood cannot supply the muscles and nerves with oxygen and nutrients. Fasciotomy for chronic compartment syndrome this protocol was developed for patients who have had lower leg compartment releases. Compartment syndrome after abdominal aortic aneurysm repair tadashi omoto, atsushi aoki, kazuto maruta and tomoaki masuda. Learn about the leg fasciotomy, an online 3dvideobased course, accredited by the royal college of surgeons of england. Ultrasoundguided fasciotomy for anterior chronic exertional compartment syndrome of the leg hronic exertional compartment syndrome is characterized by exertional pain, which usually affects the myofascial compartments of the leg.
Conclusion fasciotomy significantly decreased pain during activity in patients with anterior and posterior cecs. Lower extremity calf deep peroneal nerve most commonly affected anterior compartment. I had an acute compartment syndrome on my lower right leg so i did a fasciotomy compartment syndrome chronic compartment syndrome, i had fasciotomy three times, the last one took out scar tissue lower leg fasciotomy for compartment syndrome chronic localized leg pain unsolved 2. Chronic exertional compartment syndrome can present either as anterolateral lower leg pain or as painful muscle herniation. Muscles are surrounded by connective tissue known as fascia and is particularly dense in the arms and legs. There are four compartments in the lower leg one in the front, one on the outside, and two in the back superficial and deep.
Compartment syndrome cs is a serious limb threatening. Lower extremity compartment syndrome trauma surgery. Compartment syndromes of the lower extremity most frequently occur below the knee. Although endoscopic techniques have been introduced, open fasciotomy remains the mainstay of surgical treatment because of the paucity of evidence in support of an endoscopic approach. The leg is the most frequently affected site in the lower extremity requiring fasciotomy 1,2. Athletes who have a release of the anterior and lateral compartments have a high success rate. Military personnel and patients with posterior compartment. Joint trauma system extremity compartment syndrome cs. The diagnosis is based on clinical examination and intracompartmental pressure measurement. Fasciotomy for chronic exertional compartment syndrome day of surgery a. Compartment syndrome and fasciotomy in vascular surgery. The fasciotomy of the lower leg can be done with either a single incision or two incisions. The patient underwent bilateral lower extremity, thigh, gluteal, and right upper extremity compartment fasciotomies, with the left lower extremity being the single, traumatically injured extremity.
Chronic exertional compartment syndrome cecs is a significant source of lower extremity pain and morbidity in the athletic population. Acute compartment syndrome acs of the lower leg is a timesensitive orthopedic emergency that relies heavily on precise clinical findings. A singleincision fasciotomy for compartment syndrome of. While the postop dressing is in place, icing should be done. This course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test.
Single minimal incision fasciotomy for chronic exertional. Chronic exertional compartment syndrome cecs involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. Make longitudinal fascial incisions, approximately the length of the skin incision, in the superficial posterior. Muscles in the forearm, lower leg and other body areas are surrounded by fibrous bands of tissues.
The clinica diagnosis of compartment syndrome of the lower leg. The leg is the most frequently affected site in the lower extremity requiring fasciotomy. Any concern for compartment syndrome based on mechanism, or the presence of pain in the affected extremity, should prompt a compartment pressure check. Compartment syndrome release with open fasciotomy uw health. Fasciotomy of the lower leg the lower leg calf is the most common site for cs requiring fasciotomy. Recurrent pain in the lower leg caused by exercise is a common problem in athletes. Compartment syndrome of the lower leg and foot springerlink. Management of chronic exertional compartment syndrome and. Open 4compartment fasciotomy for chronic exertional compartment syndrome of the leg amos z. Hoffmanns syndrome necessitating forearm fasciotomy.
Rehabilitation guidelines following compartment syndrome release with open fasciotomy chronic exertional compartment syndrome cecs is a painful condition of the lower leg that affects many runners and other athletes involved in repetitive impact activities. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. The aim of this article is to describe a variation of an existing singleincision technique that will allow for the release of all four compartments with 1 incision. The optimal surgical approach for acute compartment syndrome acs of the lower leg remains debatable. This operation becomes necessary in patients who are suffering from and who are at. The lower leg and foot are the most common zones affected by the reperfusion syndrome. Current literature indicates that goodtoexcellent outcomes can be expected for 90% to 95% of patients treated with fasciotomy.
The lower leg seems to be the most common location of compartment syndrome associated with hypothyroidism, with five previously published cases involving fasciotomy of tibial compartments 15. Sixtyone percent of the fasciotomies revised were to the lower leg and. Compartment syndrome most often occurs in the anterior front compartment of the lower leg calf. A fasciotomy can be done on most areas of the body, but it is most common on the arm or leg. Compartment syndrome release with open fasciotomy rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. When compartment syndrome is diagnosed in the lower leg, it is recommended to decompress all of the.
Fasciotomy is a procedure that cuts open the fascia and relives pressure. Exercise induced compartment syndrome in a professional. The condition is nearly evenly split between males and females. Compartment syndrome of the leg is an orthopaedic emergency and can be treated with single or dualincision fasciotomy, allowing for necessary decompression of all four compartments. Acute compartment syndrome and fasciotomy of the lower. Pdf all clinicians caring for traumatically injured patients must be able to recognize and treat or refer for treatment compartment syndrome cs of. To the best of our knowledge, only one patient with hypothyroidinduced compartment syndrome in the forearm has previously been reported. Subcutaneous fasciotomy does not always ensure sufficient decompression of all four lower leg compartments. Physical therapy section fasciotomy for chronic compartment syndrome revised november 2016 adapted from william beaumont army medical center postop days 1 14 crutches non weight bearing nwb x 4wks arom hip and knee wiggle toes, gentle ankle arom dfpf as tolerated straight legraise slr x 4.