Sports Medicine: Just the Facts

running the potential and the kinetic energies are in

phase (i.e., when one is minimum or maximum, so is

the other), which means that energy is periodically

stored and released. This action is performed mainly

by the muscle tendons, which behave as springs acti-

vated by the relevant muscles.

• In analyzing gait (in particular, an atypical gait pat-
  tern or an effect of a shoe-type, brace, musculoskele-
  tal injury or impairment), at least two distinct
  qualities need to be considered. The first is energet-
  ics, i.e., how does the pattern, shoe, etc., affect ener-
  getics—this can be measured directly with oxygen
  consumption and indirectly with CoM calculations
  and by observing if EMG activities are consistent
  with kinetic needs. The second is risk for biomechan-
  ical injury, i.e., how does the pattern affect risk over
  time, for ligamentous, muscle, tendon, cartilage, or
  bone injury—this is best estimated with joint kinet-
  ics, in particular joint moments, which may be higher
  than normal indicating a greater risk for biomechani-
  cal injury.

REFERENCES

Birrer RB, Buzermanis S, DellaCorte MP, et al: Bio-mechanics of
running, in O’Connor F, Wilder R (eds): The Textbook of
Running Medicine.New York, NY, McGraw-Hill, 2001, pp
11–19.
Kerrigan DC, Edelstein JE: Gait, in Gonzalez EG, et al (eds.): The
Physiological Basis of Rehabilitation Medicine.Boston, MA,
Butterworth-Heinemann, 2001, pp 397–416.
Novacheck TF: The biomechanics of running. Gait Posture
7:77–95, 1998.
Perry J: Gait Analysis: Normal and Pathological Function.
Thorofare, NJ, SLACK, 1992.

22 COMPARTMENT SYNDROME

TESTING

John E Glorioso, MD

John H Wilckens, MD

INTRODUCTION

•Exertional leg pain is a common complaint in the run-
ning athlete. The differential diagnosis includes stress
fracture, tibial stress reaction such as periostitis or

medial tibial stress syndrome (shin splints), ten-

donitis, nerve compression or entrapment, and

chronic exertional compartment syndrome(CECS).

• Though a classic history may suggest the diagnosis of
  CECS, an exercise challenge and measurement of
  compartmental pressures is essential to confirm the
  diagnosis.


• Intracompartmental pressure measurement is the most
  clinically useful test to rule out or confirm CECS as
  the etiology of exertional leg pain.

COMPARTMENT SYNDROMES

• Compartment syndrome exists when tissue pressures
  are elevated in a restricted fascial space resulting in
  decreased perfusion causing nerve and muscle
  ischemia.


• Compartment syndromes in the athlete can occur in
  two forms, acute and chronic. The distinction
  between the two is in the reversibility of the ischemic
  insult.


• In acute compartment syndrome, the ischemia is irre-
  versible and rapidly leads to tissue necrosis unless
  emergently decompressed via fasciotomy.
  
  
  • Most commonly occurs with acute trauma (fracture)
    or soft tissue/muscle injury (crush injury, rhab-
    domyolysis)
    •A clinical diagnosis made by historical and physical
    examination findings. Characteristic findings
    include pain out of proportion to injury, presence of
    paresthesias and sensory deficits, tense and swollen
    compartment on palpation, decreased or loss of
    active motion, and severe pain with passive stretch.
    •Treatment is emergent surgical decompression via
    fasciotomy.
  
  
  • If doubt exists as to the diagnosis in the acute pres-
    entation, intracompartmental pressure measure-
    ments may be indicated prior to emergent
    fasciotomy.
  
  
  • Resting intracompartmental pressures of greater
    than 30 mmHg is the generally accepted level that
    can be associated with decreased blood flow and
    resultant muscle and nerve ischemia (Andrish,
    2003).
  
  
  
  


• CECS involves reversible ischemia that is exercise
  induced and occurs at a predictable distance/intensity
  of exertion.
  
  
  • This form is much more common in athletes.
  
  
  • The reversible ischemia of exertional compartment
    syndrome occurs secondary to a noncomplaint osse-
    ofascial compartment that is not responsive to the
    expansion of muscle volume that occurs with exer-
    cise.
  
  
  
  

130 SECTION 2 • EVALUATION OF THE INJURED ATHLETE