Leg > Compartment Syndrome

What is Compartment Syndrome?

Compartment syndrome is not a well-known injury to most recreational athletes, but it can be very serious if not treated. There is a layer of tissue around muscles called fascia. When exercising, muscles enlarge but sometimes the fascia, which is like an envelope, will not expand with the muscle, creating pressure and potentially causing damage to the nerve and muscle cells. The pressure build-up is called compartment syndrome. Compartment syndrome is a more serious condition than shin splints, though the two are often confused by athletes. Shin splints are a type of start-up, beginning-of-training leg pain that should resolve in about two weeks once the person starts to work his way into shape. If the pain does not go away, then you need to reevaluate the diagnosis.

There are two ways to develop compartment syndrome, which most often occurs in the lower leg:

   A broken bone, such as the lower-leg fracture suffered by San Francisco 49er defensive end Bryant Young during the 1998 season. This can cause the surrounding tissues to bleed and the muscles to swell. The fascia cannot expand, so pressure builds; if the pressure exceeds the blood supply coming into the muscle compartment, blood may stop flowing into the compartment and the tissues and muscles can actually die.

   Exercise activities such as running and tennis can increase the pressure in the muscle compartment, and can lead to a chronic exertional compartment syndrome, which develops over a long period of time.

Surgery, which releases the muscle compartment so that there is more room in which the muscle can function, is usually the treatment of choice for compartment syndrome and usually has good results. Non-surgical treatments are usually ineffective. First, the diagnosis must be confirmed and other injuries, such as stress fractures and tendinitis, must be ruled out.

   X-rays and bone scans can identify stress fractures and other injuries.

   The pressure in the muscle compartment must be measured. This is done by placing a tiny catheter inside the compartment, which measures muscle pressure before, during, and after exercise. This will identify abnormal pressure.

   There is some interest in using MRI (magnetic resonance imaging) to make a diagnosis, but it is probably not as accurate – though it is appealing because it is non-invasive.

Jan Fronek, M.D. is head team physician for the San Diego Padres and a member of Professional Team Physicians.