Transcript Anterior Compartment Syndrome

Anterior Compartment
Syndrome
By Marie and Molly
History
20 year old female soccer player
 Midfield Position
 During one of the last practice sessions of
the season was kicked in the shin by
another player
 Athlete was not wearing shin guards

Signs and Symptoms
Pt. c/o pn w/passive plantar flexion
 Pn along ant. Aspect of lower leg
 Palpation reveals hardness and tension
w/soft tissue
 Shiny or pallor skin
 Distal pulse diminished
 Numbness and tingling radiating to toes

Diagnosis
Pt. has Anterior Compartment Syndrome
 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
 A fasciotomy is performed to release
pressure in the compartment
 95% success rate

Treatment

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
Must be place on crutches w/non-weight
bearing for 7-10 days
 Friction massage by incision for soft-tissue
mobility
 Gait training
 NSAIDS

Goals for Post-Op
Full ROM
 Biking/Swimming 2-4 weeks

– Swimming when wound heals
Jogging at 4-6 weeks
 Sports participation 6-8 weeks

– Athlete should be able to run 2-3 miles pn
free before returning to play
Modalities
Milk Massage
 Myofascial release

– Release scar tissue
Ice Bag/slush bucket
 Heat

– Start 3rd week
Week 1
Non-weight bearing
 Check wound dressing daily

Week 2

Partial weight-bearing
– 2 point gait

Isometric exercises
– Inversion
– Eversion
– Planter flexion
– Dorsiflexion

Toe Exercises
– Towel rolls
Week 2 cont.
Alphabet
 Weight-scale exercise
 Stretching

– Gastroc stretch
– Soleus stretch
– Achilles stretch
– Dorsiflex stretch
Week 3/4
Arm Bike/Elliptical
 Gait training
 POOL

– Single leg stance
– Grapevine
– Step ups
– Gastro/soleus stretch
– Heel raises
Week 3/4 Cont.
Ankle Walking
 Double knee bend
 Seated knee extension
 Team core work-out

Week 5/6
Underwater treadmill
 BAPS board

– Two legs

Closed kinetic chain
– 4 Lunges
– Squats both legs
– Leg presses
Week 5/6
– Terminal knee ext.
– Heel raises
Lower leg and foot stretches
 Rubber Tubing

– Inversion/eversion
– Plantar/dorsiflexion
Week 7/8
Warm up walking on treadmill
 Stair climber
 Treadmill jogging ½ mile to 1 mile
 Lower leg stretches
 BAPS board

– One leg
4 Lunges w/tubing
 Leg press
– More weight
Week 7/8 cont.
Heel raises
 Tubing exercises w/increase resistances
 Lunges w/tubing

Week 9/10
Running on the field
 Swimming
 Box jumping
 Dot drills
 Long/short passing
 Ball Juggling
 Backwards running w/ball kicking
 Z-lines w/ball
 Corner Kick drills

Week 9/10
During last week they must pass
functional tests before moving to
functional exercises
 Must be pain free
 Functional exercise

– Scrimmage
Practice
Return to play w/shin guards
 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:
– Increase swelling
– Increase pain
– Numbness or tingling
If any apply, modify the rehab
 Everything is as tolerated

– May need to continue rehab longer than
expected