Anterior Compartment Syndrome – Treatment, Symptoms, Surgery

What is Anterior Compartment Syndrome?

The anterior compartment syndrome is defined as increased pressure on the lower leg muscles initiating pain. The condition is sometimes identified as anterior shin splints. It is recognized as anterior when the big muscle of the shin is affected, anatomically known as tibialis anterior. Accordingly, the anterior compartment of the shin is enclosed by the tibia and fibula.

These two long bones are our calf bones that are located lateral from each other, bearing our weight. Because of an injury or any form of pressure applied in the anterior compartment, the condition arise inducing pain. Thissyndrome should not be taken lightly, as this prompts as a medical emergency.

The medical team would aim to avoid development of necrosis of the tissues, which is a possible complication of the disease. The said condition should not be confused with the posterior anterior syndrome, as PAS is less common than anterior compartment syndrome.

The Anterior Compartment on the Leg Showing Swelling

Anterior Compartment Syndrome Symptoms

Those affected of anterior compartment syndrome would usually complain of the following:

• Pain and tenderness on the lower leg.
• Paresthesia of the affected leg. This is defined as a tingling and prickling sensation and numbness of the skin. This is usually defined by patients as a dead feeling of the leg.
• Passive movement or stretching of the affected muscles increases the pain and discomfort.
• There are instances that the condition is painless.

Swelling on the Lower Leg That Characterize Anterior Compartment Syndrome

Causes of Anterior Compartment Syndrome

The anterior compartment syndrome is usually caused by the overuse of the anterior compartment. It has been noted that an unaccustomed or a barely used type of exercise that involves the anterior compartment can lead to the syndrome. Simply, straining the muscles increases the risk of anterior compartment syndrome. Increased tension in the anterior compartment also causes the syndrome. The following are considered some of the risk factors of anterior compartment syndrome:

• Over-work of the feet and calves during activities or exercises. Increasing ones pace during a run can result to anterior compartment syndrome.
• Application of a constricting material around the lower leg can impede good blood circulation. This can induce swelling and movement restriction. This can possibly lead to a mild degree form of anterior compartment syndrome.
• Improper shoes such as short ones can result to anterior compartment syndrome. Shoes that are too rigid are possible causes of shin splints. There are some dancers at risk of this syndrome.Their dance routines, improper foot posture or simply their footwear can be the root cause of the emergence of the condition.
• Being an athlete brings the person at risk for this condition, like some known syndromes that affect the muscles such as rotator cuff syndrome (a condition that affects the muscles that support our shoulder blades). Runners, in particular, are prone to such syndrome.

Diagnosis

There is a definitive diagnostic examination for anterior compartment syndrome. The measurement of the intramuscular pressure shall assist in the diagnosis of the syndrome. The method shall include 3 techniques. The first technique involve the use a mercury manometer and a needle, called the Whitesides technique.

This procedure is an out-patient type of test. The next technique was made known by Mubarak and some associates, using a fiber-filled polyethylene catheter  to test the pressure in the anterior compartment as it is inserted into the area while a pressure transducer will present the assessment. Another technique made known by Matsen uses another form of catheter but is constituted with low-rate infusion so that pressure can be well monitored in the process; however it takes three days for the assessment to finish. The result that suggests anterior compartment syndrome is 30-50 mmHg pressure.

Imaging tests are done in order to rule out other possible conditions. There is a great possibility that an underlying fracture has been the root cause of the presenting symptoms, which is another form of problem that may be alike anterior compartment syndrome.

Anterior Compartment Syndrome Treatment

Treatment for this said syndrome is quite dependent on the severity of the case. When the condition is said to be not severe, a conservative treatment is indicated for patients.

• Elevation of the affected leg can reduce the swelling that has developed.
• Application of ice is also a good management for the swelling and pain sensation. This can be done in alternation with a hot compress. The patient’s preference is always considered with application of compress.
• Stimulating for good circulation and proper venous return can be attained through an interferential therapy of the ankle towards the groin. The process shall involve specialists to do the task and so to avoid aggravating the situation of the client. A physiotherapist can assist the client alleviating the presenting symptoms.
• Exercising the client’s calf or the leg shall not be concentrated on these areas but shall include also include the feet, hamstrings, gluteal muscles (muscles of the buttocks) and the adductor muscles.
• Dancers or athletes are advised to sleep with their feet elevated. This can be done with the use of a pillow placed under the foot of the sufferer.
• Analgesics are provided for relief.
• The specialist shall recommend the client to do simple exercises. Taking some rest from their usual routine is also recommended.
• Massage is somehow recommended to some patients. This can be very effective in the rehabilitative program.
• As the syndrome does not respond from the conservative treatment, surgery is indicated. This shall aim in reducing the pressure found in the muscle compartment. In this method, there shall be removal of the affected connective tissue. This can somehow avoid for future episodes of anterior compartment syndrome, leaving no room for muscle swelling.

Prognosis

Prognosis of the condition is considered good. According to reports, most of the patients with anterior compartment syndrome have recovered from it as long as treatment has been acquired. This is also dependent on the severity of the condition and the type of treatment rendered to the patient.

Complications

The most unlikeable complication of anterior compartment syndrome is the development of muscle necrosis. This shall occur when the condition has reached its most severe point and that proper treatment has not been provided accordingly.

An underlying fracture of the tibia can be easily missed as an anterior compartment syndrome, which can cause a complication when not identified early and provided with appropriate actions.