Identifying Chronic Compartment Syndrome
Symptoms consistent with other ailments of the lower extremities can delay definitive diagnosis of chronic compartment syndrome for up to two years. Learn how to identify and work-up the chronic compartment syndrome patient and refer to a vascular surgeon.
Chronic compartment syndrome is a nerve and muscle threatening condition which typically manifests in the lower extremities. It can be either acute or chronic.
The acute condition results from trauma and is generally treated in an emergency setting, whereas the chronic condition results from overuse injury – excess fluid accumulation in the confined space of the muscle fiber – most often times in the lower leg.
Who is at risk for chronic compartment syndrome?
Chronic compartment syndrome is typically seen in patients with jobs that demand long periods of time on their feet, or in athletes performing repetitive high impact activity.
Providers should be suspicious of lower leg pain in the following demographics:
Many of the symptoms associated with chronic compartment syndrome are consistent with other ailments of the lower extremities. A definitive diagnosis could take up to two years of enduring symptoms, despite treatment attempts for differential diagnoses.
Common misdiagnoses include:
Diagnosis and Work-up
Often times, a physical exam is unremarkable and does not reveal if compartment syndrome is the culprit of chronic lower leg pain.
Patients with compartment syndrome exhibit a consistent, predictable and reproducible trajectory of symptoms during physical activity.
Once the patient begins the pain-inducing exercise they will experience:
If compartment syndrome is suspected, the provider can take an intracompartmental pressure measurement to confirm the diagnosis. The Stryker Catheter is the most widely used device for this testing. A resting pressure and a five minute post-exercise pressure measurement should be recorded.
A positive diagnosis is represented by:
Treatment options can vary for each individual. While a non-surgical, conservative approach could include rest, anti-inflammatory medication, and physical therapy; it will likely only alleviate symptoms briefly. A surgical approach can deliver permanent relief and allow the patient to return to their desired level of physical activity.
The UW Health Compartment Syndrome Clinic
William D Turnipseed, MD leads one of the only clinics in the country dedicated to the treatment of chronic compartment syndrome at UW Health. Dr. Turnipseed has been treating patients with compartment syndrome since 1980 – the year he standardized the surgical treatment for the condition.
His team has successfully treated more than 2,100 patients with compartment syndrome; and in 2013, the UW Health Compartment Syndrome Clinic welcomed vascular surgeon Travis Engelbert, MD , an elite athlete and former compartment syndrome patient, to expand upon the surgical services available to individuals suffering from the chronic condition.
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Turnipseed, William. “Diagnosis and management of chronic compartment syndrome.” Surgery. 132.4 (2002): 613-7.