Dupuytren's Contracture

Dupuytren's contracture is a thickening of the fibrous tissue layer underneath the skin of the palm and fingers. Although painless, the thickening and tightening (contracture) of this fibrous tissue can cause the fingers to curl (flex).

Dupuytren's contracture is more common in men than in women.

Cause 


Symptoms of Dupuytren's contracture include painful bumps (nodules) under the skin that develop into tight bands of tissue, causing the
fingers to curl.

The cause of Dupuytren's contracture is not known. It is not caused by an injury or heavy hand use.

There are factors that put people at greater risk for developing Dupuytren's contracture.

• It is most common in people of Northern European (English, Irish, Scottish,    French, Dutch) or Scandinavian (Swedish, Norwegian, Finnish) ancestry.
• It often runs in families (hereditary).
• It may be associated with drinking alcohol.
• It is associated with certain medical conditions, such as diabetes and seizures.
• It increases in frequency with age.


Symptoms 

Dupuytren's contracture symptoms usually occur very gradually.

Nodules. One or more small, tender lumps (nodules) form in the palm. Over time, the tenderness usually goes away.

Bands of tissue. The nodules may thicken and contract, forming tough bands of tissue under the  skin.

Curled fingers. One or more fingers bend (flex) toward the palm. The ring and little fingers are  most commonly affected, but any or all fingers can be involved. As the bend in the finger  increases, it may be hard to straighten your finger. Grasping large objects and putting your hand  in a pocket becomes difficult.



Doctor Examination 

Your doctor will examine your hand and test the feeling in your thumb and fingers. Your grip and pinch strength may also be tested.

During the examination, your doctor will record the locations of nodules and bands on your palm. Using a special device, he or she will measure the amount of contracture in your fingers.
Your doctor may also measure the range of motion in your fingers to determine whether there is limitation in your flexion.


Your doctor will measure the bend in your finger, and note where the bands of tissue and nodules are.

Your doctor will refer back to these measurements throughout your treatment to determine whether the disease is progressing.



Treatment 

There is no way to stop or cure Dupuytren's contracture. However, it is not dangerous.
Dupuytren's contracture usually progresses very slowly and may not become troublesome for years. It may never progress beyond lumps in the palm.

If the condition progresses, nonsurgical treatment may help to slow the disease.



Nonsurgical Treatment 

Steroid injection. If a lump is painful, an injection of corticosteroid -a powerful antiinflammatory medication -may help relieve the pain. In some cases, it may prevent the progression of contracture. Several injections may be needed for a lasting effect.

Splints. Splinting does not prevent increased bend in the finger. Forceful stretching of the contracted finger will not help either, and may speed the progression of contracture.


Surgical Treatment 

Surgery is recommended when your doctor has confirmed through measurements over time that the disease is progressing. Some patients turn to surgical treatment when hand function is limited; they have trouble grasping objects or putting their hands in their pockets.

Surgical procedure. Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may be needed.

Complications. Although rare, risks of surgery include injury to nerves and blood vessels, and infection. Permanent stiffness of the fingers may occur, although this is also rare.

Recovery. Some swelling and soreness are expected after surgery, but severe problems are rare.

After surgery, elevating your hand above your heart and gently moving your fingers help to  relieve pain, swelling, and stiffness.

Physical therapy may be helpful during recovery after surgery. Specific exercises can help strengthen your hands and help you move your fingers.

Most people will be able to move their fingers better after surgery.

Recurrence. Approximately 20% of patients experience some degree of recurrence. This may require further surgery.


New Developments 

Experiments are being performed with enzyme injections that may be able to break down the tough bands and improve motion without surgery. Early results are promising, but these injections are not available for general use at this time.

A new, less invasive procedure called needle aponeurotomy is being performed by some hand surgeons. Recovery is much faster, but long-term outcome is unknown. The procedure requires special technical expertise and has greater risk of nerve and/or vessel damage.

Down Syndrome: Musculoskeletal Effects

Down syndrome is one of the most common genetic disorders. According to the Centers for Disease Control and Prevention, it affects about 13 babies in every 10,000 births. Its primary  effect is mental retardation and a number of physical abnormalities.

The child may have special medical problems of the heart, stomach, eyes and other parts of the  body. Some problems in Down syndrome involve the bones and joints (musculoskeletal system).

Symptoms 


X-ray of the pelvis shows that the patient's left hip is dislocated.

A child with Down syndrome may have weak muscle tone (hypotonia). He or she may also have  ligaments that are too loose (ligament laxity). This leads to excessive joint flexibility.

Associated  findings include:

•  Developmental delays. A child with Down syndrome will eventually reach the same  growth milestones as other children. But, he or she may be slow learning to turn over, sit,  stand, walk or do other physical activities.
•  Joint instability. Children with Down syndrome may have joints, such as the hip or  knee, which slip out of place or become dislocated. Joint laxity in the neck may be  excessive. This can lead to compression of the spinal cord.
•  Other Problems. Down syndrome may also lead to other problems, such as flat feet and  bunions.


Nonsurgical Treatment 

Getting early medical care and treatment (intervention) can improve the health of a child with  Down syndrome and address some musculoskeletal problems.

Because children grow most rapidly during the first three years of life, it is important that the  child have a comprehensive medical examination at birth.


Physical Therapy 

The doctor may recommend a special program of physical therapy, exercise, and other activities  early on. Early intervention can help a child with Down syndrome achieve developmental skills  and build muscle tone and coordination. It can also give extra stimulation and encouragement to  help the child achieve his or her full potential in life. Many children with Down syndrome go on  to hold jobs and live independently well into middle age and beyond.

Early diagnosis and treatment is also important for managing orthopaedic problems in children with Down syndrome. Some children may need splints or other devices for physical activity.  Sometimes your doctor may refer you to a pediatric orthopaedist for specialized help or surgery.



Neck Instability 

In some people with Down syndrome, the upper part of the spine (cervical) is abnormal under  the base of the skull. Muscles are weak and ligaments may be looser than they should be.
Potentially, this can cause bones (vertebrae) in the neck to press on the spinal cord, leading to an inability to coordinate muscle movement and weakness.

Any progressive changes in a child with Down syndrome should be brought to the doctor's  attention. These changes may include:

•  Weakness, clumsiness and tripping
•  Walking with stiff legs
•  Having a stiff neck, neck pain, and headaches
•  The doctor may recommend taking X-rays of your child's neck to look for joint laxity. In  some cases, a child may be kept out of contact sports or other activities that put stress on  the neck, such as high jumping, diving, gymnastics, and using a trampoline.


Staying Active 

A child with Down syndrome should be encouraged to be physically active and consume a  healthy diet. This will help them avoid excess weight gain and other physical problems. Your  doctor can help develop a well-rounded exercise routine that includes aerobic activity, strength  training, and stretching exercises.


Surgical Treatment 

Occasionally, a child with Down syndrome may need a type of surgery called spinal fusion to  hold the bones in the neck together. This will prevent excessive pressure on the spinal cord.

Surgery may also occasionally be needed to manage looseness of the hip and knee joints and  looseness of the joints in the feet.

De Quervain's Tendinitis

De Quervain's tendinitis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinitis" refers to a swelling of the tendons. Thickening of the tendons can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping things, or when turning the wrist.

Anatomy
Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through the tunnel. Any swelling of the tendons located near these nerves can put pressure on the nerves. This can cause wrist pain or numbness in the fingers. De Quervain tenosynovitis of the first extensor compartment.



Causes
De Quervain's tendinitis is caused when tendons on the thumb side of the wrist are swollen or irritated. The irritation causes the lining (synovium) around the tendon to swell, which changes the shape of the compartment. This makes it difficult for the tendons to move as they should.
Tendinitis may be caused by overuse. It can be seen in association with pregnancy. It may befound in inflammatory arthritis, such as rheumatoid disease. De Quervain's tendinitis is usually most common in middle-aged women.

Symptoms
Signs of De Quervain's tendinitis:
• Pain may be felt over the thumb side of the wrist. This is the main symptom. The    pain may appear either gradually or suddenly. Pain is felt in the wrist and can    travel up the forearm. The pain is usually worse when the hand and thumb are in     use. This is especially true when forcefully grasping objects or twisting the wrist.
• Swelling may be seen over the thumb side of the wrist. This swelling may occur    together with a fluid-filled cyst in this region.
• A "catching" or "snapping" sensation may be felt when moving the thumb.
• Pain and swelling may make it difficult to move the thumb and wrist.
• Numbness may be experienced on the back of the thumb and index finger. This    is caused as the nerve lying on top of the tendon sheath is irritated.



Diagnosis
The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger. Finkelstein test. Arrow indicates location of pain when test is positive.

The Finkelstein test can be quite painful for the person with De Quervain's tendinitis. Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.

Treatment
The goal in treating de Quervain's tendinitis is to relieve the pain caused by irritation and swelling.

Nonsurgical Treatment
• Splints. Splints may be used to rest the thumb and wrist.
• Anti-inflammatory medication (NSAIDs). These medications can be taken by
mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.
• Avoiding activities that cause pain and swelling. This may allow the symptoms to
go away on their own.
• Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.


Surgical Treatment
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons. Normal use of the hand usually can be resumed once comfort and strength have returned. Your orthopaedic surgeon can advise you on the best treatment for your situation.

Corns

Every day, the average person spends several hours on their feet and takes several thousand steps. Walking puts pressure on your feet that's equivalent to 2-3 times your body weight. No wonder your feet hurt!

Actually, most foot problems can be blamed not on walking but on your walking shoes. Corns, for example, are calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small
toe. Soft corns resemble open sores and develop between the toes as they rub against each other.

Cause

• Shoes that don't fit properly. If shoes are too tight, they squeeze the foot, increasing pressure. If they are too loose, the foot may slide and rub against the shoe, creating friction.
• Toe deformities, such as hammer toe or claw toe.
• High heeled shoes because they increase the pressure on the forefoot.
• Rubbing against a seam or stitch inside the shoe.
• Socks that don't fit properly.

Diagnosis and Treatment

Corns can usually be easily seen. They may have a tender spot in the middle, surrounded by yellowish dead skin. Treating foot problems like corns is a team effort. You will need to work with your physician to ensure that problems don't recur.

During your office visit

• To restore the normal contour of the skin and relieve pain, your doctor may trim the corn by shaving the dead layers of skin off with a scalpel. This procedure should be done by a professional, and not by yourself, particularly if you have poor circulation, poor eyesight, or a lack of feeling in your feet.
• If the doctor discovers an underlying problem, such as a toe deformity, he or she can correct it. Most surgeries can be done on an outpatient basis.
At home
• You can soak your feet regularly and use a pumice stone or callus file to soften and reduce the size of corns and calluses.
• Wearing a donut-shaped foam pad over the corn will also help relieve the pressure. Use non-medicated corn pads; medicated pads may increase irritation and result in infection.
• Use a bit of lamb's wool (not cotton) between your toes to help cushion soft corns.
• Wear shoes that fit properly and have a roomy toe area.

Congenital Scoliosis

Congenital scoliosis is a sideways curvature of the spine that is caused by a
defect that was present at birth. It occurs in only 1 in 10,000 newborns and is
much less common than the type of scoliosis that begins in adolescence.
Children with congenital scoliosis sometimes have other health issues, such as
kidney or bladder problems.

Even though congenital scoliosis is present at birth, it is sometimes impossible to
see any spine problems until a child reaches adolescence.

Types of Congenital Scoliosis

A single hemivertebra in the lower back shown in a 3-D image from a computed
tomography (CT) scan. Note the four normal rectangular vertebra below the
single triangular-shaped hemivertebra (arrow). This wedged vertebra creates the
deformity that would not have otherwise been there.


Incomplete Formation of Vertebrae

As the spine forms before birth, part of one vertebra (or more) may not form
completely. When this occurs, the abnormality is called a hemivertebra and can
produce a sharp angle in the spine. The angle can get worse as the child grows.
This abnormality can happen in just one vertebra or in many throughout the
spine. When there is more than one hemivertebra, they will sometimes balance
each other out and make the spine more stable.

Failure of Separation of Vertebrae

During fetal development, the spine forms first as a single column of tissue that
later separates into segments that become the bony vertebrae. If this separation
is not complete, the result may be a partial fusion (boney bar) joining two or
more vertebrae together.
Such a bar prevents the spine from growing on one side after a child is born.
This results in a spinal curve that increases as a child grows.


Combination of Bars and Hemivertebrae

The combination of a bar on one side of the spine and a hemivertebra on the
other causes the most severe growth problem. These cases can require surgery
at an early age to stop the increased curvature of the spine.

Compensatory Curves

In addition to scoliosis curves, a child's spine may also develop compensatory
curves in order to maintain an upright posture. This occurs when the spine tries
to make up for a scoliosis curve by creating other curves in the opposite
direction above, or below, the affected area. The vertebrae are shaped normally
in compensatory curves.

Symptoms

This 4-year-old girl's body shifts to the left. One hip looks higher than the other
and her waistline is not the same shape on the two sides.
Congenital scoliosis is often detected during the pediatrician's examination at
birth because of a slight abnormality of the back.
Scoliosis is not painful, so if the curvature is not detected at birth, it can go
undetected until there are obvious signs --which could be as late as
adolescence. A child may suspect that something is wrong when clothes do not
fit properly. Parents can discover the problem in early summer when they see
their child in a bathing suit.

The physical signs of scoliosis include:

• Tilted, uneven shoulders, with one shoulder blade protruding more than the other
• Prominence of the ribs on one side
• Uneven waistline
• One hip higher than the other
• Overall appearance of leaning to the side
• In rare cases there may be a problem with the spinal cord or nerves that
   produces weakness, numbness, or a loss of coordination.


Doctor Examination and Investigation

Physical Examination

The standard screening test for scoliosis is the forward bending test. Your child
will bend forward and your doctor will observe your child from the back, looking
for a difference in the shape of the ribs on each side. A spinal deformity will be
most noticeable when your child is in this position.
With your child standing upright, your doctor will check to see if the hips are
level, the shoulders are level, and that the position of the head is centered over
the hips. He or she will check the movement of the spine in all directions.
To rule out the presence of a spinal cord or nerve problem, your doctor may
check the strength in your child's legs and the reflexes in the abdomen and legs.

Tests

This adolescent girl's curve and the hemivertebra causing it show up clearly on
x-ray.
Although the forward bending test can detect scoliosis, it cannot detect the
presence of congenital abnormalities. Imaging tests can provide more
information.

X-rays. Images of your child's spine are taken from the back and the side. The
x-rays will show the abnormal vertebra(e) and how severe the curve is.
Once your doctor makes the diagnosis of congenital scoliosis, your child will be
referred to a pediatric orthopaedic surgeon for specialized care and further
tests.

Computed tomography (CT) scan. A CT scan can provide a detailed image of
your child's spine, showing the size, shape, and position of the vertebrae. To
see the vertebrae better, your doctor may have a 3-D image made from the CT
scan. This looks like a photograph of the bones.
This 3-D image from a CT scan shows hemivertebrae, as well as a fused, boney
block.

Ultrasound. Your doctor will do an ultrasound of your child's kidneys to detect
any problems.
Magnetic resonance imaging (MRI) scan. Because an MRI can evaluate soft tissues
better than a CT scan, an MRI will be done to check for abnormalities of the
spinal cord at least once for every patient.


Treatment
There are several treatment options for congenital scoliosis. In planning your
child's treatment, your doctor will take into account the type of vertebral
abnormality, the severity of the curve, and any other health problems your child
has.

Your doctor will determine how likely it is that your child's curve will get worse,
and then suggest treatment options to meet your child's specific needs.

Nonsurgical Treatment

Observation. A child with a small curve that seems to be unchanging will be
monitored to make sure the curve is not getting worse. Although it does not
happen in every patient, congenital scoliosis curves can get bigger as the spine
grows and the deformity of the back becomes more noticeable. It is likely that a
curve in a young child will get worse because younger children still have a lot of
growing to do.
Your doctor will follow the changes of your child's curve using x-rays taken at
6-to 12-month intervals during the growing years.
Physical activity does not increase the risk for curve progression. Children with
congenital scoliosis can participate in most sports and hobbies.
Bracing or casting. Braces or casts are not effective in treating the curvature
caused by the congenitally abnormal vertebrae, but they are sometimes used to
control compensatory curves where the vertebrae are normally shaped.


Surgical Treatment

Surgical treatment is reserved for patients who:

• have curves that have significantly worsened during the course of x-ray
  monitoring
• have severe curves
• have a large deformity of the spine or trunk
• are developing a neurological problem due to an abnormality in the spinal cord
An important goal of surgery is to allow the spine and chest to grow as much as
possible. There are several surgical options.

This x-ray was taken of the same patient after her surgery to remove the
hemivertebra and fuse the curved vertebrae with a metal implant.
Spinal fusion. In this procedure, the abnormal curved vertebrae are fused
together so that they heal into a single, solid bone. This will stop growth
completely in the abnormal segment of the spine and prevent the curve from
getting worse.

Hemivertebra removal. A single hemivertebra can be surgically removed. The
partial correction of the curve that is achieved by doing this can then be
maintained using metal implants. This procedure will only fuse two to three
vertebrae together.

Growing rod. Growing rods do not actually grow but can be lengthened with
minor surgery that is repeated every 6 to 8 months. The goal of a growing rod is
to allow continued growth while correcting the curve. One or two rods are
attached to the spine above and below the curve. Every 6 to 8 months, the child
returns to the doctor and the rod is lengthened to keep up with the child's
growth. When the child is full grown, the rod(s) are replaced and a spinal fusion
is performed.

Rehabilitation. Young children usually recover quickly from surgery and are
discharged from the hospital within 1 week. Depending on the operation, a child
may need to wear a cast or brace for 3 to 4 months.
Once they are healed, children are allowed to participate in most of the activities
that they had previously participated in.


Long-Term Outcomes

Congenital scoliosis detected at an early age is one of the most challenging
types of scoliosis to treat. The curves can be large to begin with and because
children have so much growth ahead of them, the chance of severe curve is
high.

Although fusion of vertebrae at an early age results in the spine and trunk being
shorter than they would have been, children can have outstanding results and
achieve normal, or near-normal, function.

Congenital Muscular Torticollis

Congenital Muscular Torticollis (Wryneck)

Congenital muscular torticollis, also called wryneck, is usually discovered in the first 6 to 8 weeks of life. The infant keeps his or her head tilted to one side and has difficulty turning the head to the opposite side.

If the infant is examined in the first month, a mass, or "tumor," may be felt in the neck. This is nontender and soft. It is attached to the muscle in the neck on the side to which the head is tilting. The mass gradually regresses so that by 4 to 6 months of age the "tumor" is gone.


A young child with a right-sided congenital muscular torticollis. Notice how the face turns away from the tight muscle. (Courtesy of Texas Scottish Rite Hospital for Children)

Congenital muscular torticollis can be associated with hip dysplasia (10% to 20%) so the hips should be examined in children with torticollis.

If you notice that your child holds the head tilted to one side, consult your physician. Other conditions can cause torticollis, and the physician will check for those during the physical examination. X-rays and/or an ultrasound of the neck and/or hips may be taken.

Ninety percent of children can be treated successfully with a stretching exercise program.

Cause

First-born children are more likely to have torticollis (and hip dislocation). This is likely from intrauterine "packing," resulting in injury to the muscle. The "tumor" is seen with response to the injury. As this resolves, the amount of scar in the muscle determines how tight the muscle is. There is no known prevention.

Symptoms

The head tilts to one side and the chin points to the opposite shoulder. The right side is involved 75% of the time. The lump is found in the muscle and it gradually goes away. There is limited range of motion of the neck. One side of the face and head may flatten as the child always sleeps on one side.

Treatment

The usual treatment consists of stretching exercises to turn the head so that the chin touches each shoulder and also so that the ear touches the shoulder.

There are other options that can help. Position toys where the infant has to turn his head to see them. Carry the child so that they have to look to the involved side. Place the child in bed with the involved side toward the wall so that they have to look the opposite way to see you outside the crib.

In 10% of children, surgery may be needed to correct the torticollis. This is an outpatient surgery to lengthen the short muscle.

Compartment Syndrome

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

Compartment syndrome can be either acute or chronic.

Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.

Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.

Anatomy

Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia. The role of the fascia is to keep the tissues in place, and, therefore, the fascia does not stretch or expand easily.


The area between the knee and ankle has four major muscle compartments: anterior, lateral, superficial posterior, deep posterior.

Description

Compartment syndrome develops when swelling or bleeding occurs within a compartment.
Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted. Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.

In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. This does not usually happen in chronic (exertional) compartment syndrome.

Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.

Cause

Acute Compartment Syndrome

Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.

Conditions that may bring on acute compartment syndrome include:

• A fracture.
• A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg with another player's helmet.
• Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.
• Crush injuries.
• Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.
• Constricting bandages. Casts and tight bandages may lead to compartment
syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.


Chronic (Exertional) Compartment Syndrome

The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.


Symptoms

Acute Compartment Syndrome

The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.

• The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.
• There may also be tingling or burning sensations (paresthesias) in the skin.
• The muscle may feel tight or full.
• Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.

Chronic (Exertional) Compartment Syndrome

Chronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg.

Symptoms may also include:

• Numbness
• Difficulty moving the foot
• Visible muscle bulging


Doctor Examination


Acute Compartment Syndrome

Go to an emergency room immediately if there is concern about acute compartment syndrome.
This is a medical emergency. Your doctor will measure the compartment pressure to determine whether you have acute compartment syndrome.

Chronic (Exertional) Compartment Syndrome

To diagnose chronic compartment syndrome, your doctor must rule out other conditions that could also cause pain in the lower leg. For example, your doctor may press on your tendons to make sure you do not have tendonitis. He or she may order an X-ray to make sure your shinbone (tibia) does not have a stress fracture.

To confirm chronic compartment syndrome, your doctor will measure the pressures in your compartment before and after exercise. If pressures remain high after exercise, you have chronic compartment syndrome.

Treatment


Acute Compartment Syndrome

Acute compartment syndrome is a surgical emergency. There is no effective nonsurgical treatment.

Your doctor will make an incision and cut open the skin and fascia covering the affected compartment. This procedure is called a fasciotomy.


Sometimes, the swelling can be severe enough that the skin incision cannot be closed immediately. The incision is surgically repaired when swelling subsides. Sometimes a skin graft is used.

Chronic (Exertional) Compartment Syndrome

Nonsurgical treatment. Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms.

Your symptoms may subside if you avoid the activity that caused the condition. Cross-training with low-impact activities may be an option. Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artficial turf vs. grass). Symptoms may be relieved by switching surfaces.

Surgical treatment. If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell.

Usually, the skin incision for chronic compartment syndrome is shorter than the incision for acute compartment syndrome. Also, this surgery is typically an elective procedure --not an emergency.