Anterior Compartment Syndrome By Marie and Molly History

Anterior Compartment Syndrome By Marie and Molly

History n 20 year old female soccer player n Midfield Position n During one of the last practice sessions of the season was kicked in the shin by another player n Athlete was not wearing shin guards

Signs and Symptoms n Pt. c/o pn w/passive plantar flexion n Pn along ant. Aspect of lower leg n Palpation reveals hardness and tension w/soft tissue n Shiny or pallor skin n Distal pulse diminished n Numbness and tingling radiating to toes

Diagnosis n Pt. has Anterior Compartment Syndrome n What is it? – There are 4 compartments in the lower leg – Each compartment holds fascia and muscle – Pressure becomes too great and there is no room for expansion – Vascular structures and neural structures can be damaged – Anterior compartment most commonly injured

Treatment n Surgery must be performed n A fasciotomy is performed to release pressure in the compartment n 95% success rate

Treatment n Muscles invloved – Tibiallis Ant. – Ext. digitorum lungus – Ext. hallicus lungus

Surgery injection Close up of cross section Fascial release Cut distally Release of peroneal nerve

Surgery Cont.

Treatment Post Op n Must be place on crutches w/non-weight bearing for 7 -10 days n Friction massage by incision for soft-tissue mobility n Gait training n NSAIDS

Goals for Post-Op n Full ROM n Biking/Swimming 2 -4 weeks – Swimming when wound heals n Jogging at 4 -6 weeks n Sports participation 6 -8 weeks – Athlete should be able to run 2 -3 miles pn free before returning to play

Modalities n Milk Massage n Myofascial release – Release scar tissue n Ice Bag/slush bucket n Heat – Start 3 rd week

Week 1 n Non-weight bearing n Check wound dressing daily

Week 2 n Partial weight-bearing – 2 point gait n Isometric exercises – Inversion – Eversion – Planter flexion – Dorsiflexion n Toe Exercises – Towel rolls

Week 2 cont. n Alphabet n Weight-scale exercise n Stretching – Gastroc stretch – Soleus stretch – Achilles stretch – Dorsiflex stretch

Week 3/4 n Arm Bike/Elliptical n Gait training n POOL – Single leg stance – Grapevine – Step ups – Gastro/soleus stretch – Heel raises

Week 3/4 Cont. n Ankle Walking n Double knee bend n Seated knee extension n Team core work-out

Week 5/6 n Underwater n BAPS treadmill board – Two legs n Closed kinetic chain – 4 Lunges – Squats both legs – Leg presses

Week 5/6 – Terminal knee ext. – Heel raises n Lower leg and foot stretches n Rubber Tubing – Inversion/eversion – Plantar/dorsiflexion

Week 7/8 n Warm up walking on treadmill n Stair climber n Treadmill jogging ½ mile to 1 mile n Lower leg stretches n BAPS board – One leg n 4 Lunges w/tubing n Leg press– More weight

Week 7/8 cont. n Heel raises n Tubing exercises w/increase resistances n Lunges w/tubing

Week 9/10 n Running on the field n Swimming n Box jumping n Dot drills n Long/short passing n Ball Juggling n Backwards running w/ball kicking n Z-lines w/ball n Corner Kick drills

Week 9/10 n During last week they must pass functional tests before moving to functional exercises n Must be pain free n Functional exercise – Scrimmage

Practice n Return to play w/shin guards n Athlete may participate in: – Upper Extremity Weight Lifting – Practice drills as tolerated w/lower ext. – Any upper extremity drills – Core work outs

Considerations n Watch for: – Increase swelling – Increase pain – Numbness or tingling n If any apply, modify the rehab n Everything is as tolerated – May need to continue rehab longer than expected