They found that ischemic changes only occurred at very high pressures (>160mmHg) which are typically not seen in exertional compartment syndrome. Balduini et al 8 used P-NMR spectroscopy to evaluate for ischemic changes in the muscle.

Amendola et al 7 used nuclear medicine blood flow studies to evaluate alterations in the muscles during chronic compartment syndrome, and saw no ischemic changes in the muscles. However, some studies have found that this may not be the case. The pain was originally thought to be an ischemic pain related to the decreased oxygenation of the tissues, insufficient muscle perfusion, and decreased return. In non-compliant compartments, it is thought that blood flow becomes insufficient to meet the requirements of the muscle, thus creating pain with activity. This equilibrium will cause a decrease in both arteriolar flow and venous return. This law explains that a capillary membrane subjected to internal and external pressures reaches an equilibrium based on those forces. In a non-compliant compartment, the increased perfusing blood volume, muscle hypertrophy, and increased interstitial fluid volume will allow increased pressure in accordance with Laplace’s law. 5 A normal compartment is able to accommodate such physiological changes during exercise however, a non-compliant compartment will lead to increased intra-compartmental pressures. This is due to increased blood flow and edema, which can cause a 20% increase in muscle volume and weight. 4ĭuring repetitive and strenuous exercise, muscle fibers can swell up to 20 times their resting size. 3Ĭhronic compartment syndrome most commonly involves the anterior and lateral compartments. A more recent theory is that there is a fifth compartment which is made up only of the posterior tibialis muscle with its own fascial covering.The deep posterior compartment contains the tibial nerve, posterior tibial artery, peroneal artery, the flexor digitorum brevis, and the flexor hallucis brevis.The superficial posterior compartment contains the sural nerve, the medial and lateral heads of the gastrocnemius muscles, and the soleus muscle.The lateral compartment encloses the superficial peroneal nerve and the peroneus longus and brevis muscles.The anterior compartment contains the anterior tibial artery, deep peroneal nerve, extensor digitorum longus, anterior tibialis, and extensor halluces longus.Each compartment contains individual muscles, nerves, arteries, and veins, encased in its own fascial membrane. Historically, the lower leg has been described as four compartments. It is imperative to understand the anatomy in the evaluation, diagnosis, and treatment of chronic compartment syndrome. 2 Typically, this condition is seen in athletics that require running and jumping thus leading to increased intramuscular pressure during training or competition.Īcute compartment syndrome, which is often seen in fractures or crush injuries to the extremities, represent emergencies and are outside the scope of this article. Incidence ranges from 14% to 39% in the general population presenting with leg pain. While it is most commonly seen in the lower leg, it has been described in the shoulder, arms, hands, thighs, and feet. It is thought to lead to reduced blood flow and tissue perfusion and is associated with repetitive exertion. Osseous spaces and the anatomic compartments. 1Ĭhronic compartment syndrome is caused by increased pressure within the closed fibro. There is typically a 22-month delay in the diagnosis and treatment of chronic compartment syndrome and popliteal artery entrapment in patients, and that delay could be detrimental to their athletic career. Exertional chronic compartment syndrome is not a common diagnosis however, it is one that is commonly overlooked. Lower leg pain experienced by athletes is typically posterior tibial tendonitis, shin splints, stress fractures, or Achilles tendonosis. A physician must be aware of many causes of lower extremity pain in these patients. Leg pain in the active and athletic patient population can be difficult to evaluate, diagnose, and treat. With an average 22-month delay in diagnosis, suspicions need to be elevated sooner. By Hayley Iosue, DPM, Joseph Albright, DPM, and Mark Mendeszoon, DPM Chronic compartment syndrome is an often-overlooked diagnosis in patients who are athletically inclined.

Lower extremity compartments