Anterior Compartment Syndrome By Marie and Molly

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

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

Diagnosis Pt. has Anterior Compartment Syndrome Pt. has Anterior Compartment Syndrome What is it? 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 Surgery must be performed Surgery must be performed A fasciotomy is performed to release pressure in the compartment A fasciotomy is performed to release pressure in the compartment 95% success rate 95% success rate

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

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

Surgery Cont.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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