Anterior Anterior Compartment Compartment

SyndromeSyndrome

By Marie and MollyBy Marie and Molly

HistoryHistory

20 year old female soccer player20 year old female soccer player Midfield PositionMidfield Position During one of the last practice During one of the last practice

sessions of the season was kicked in sessions of the season was kicked in the shin by another playerthe shin by another player

Athlete was not wearing shin guardsAthlete was not wearing shin guards

Signs and SymptomsSigns and Symptoms

Pt. c/o pn w/passive plantar flexionPt. c/o pn w/passive plantar flexion Pn along ant. Aspect of lower legPn along ant. Aspect of lower leg Palpation reveals hardness and Palpation reveals hardness and

tension w/soft tissuetension w/soft tissue Shiny or pallor skinShiny or pallor skin Distal pulse diminishedDistal pulse diminished Numbness and tingling radiating to Numbness and tingling radiating to

toestoes

DiagnosisDiagnosis

Pt. has Anterior Compartment SyndromePt. has Anterior Compartment Syndrome What is it?What is it?

– There are 4 compartments in the lower legThere are 4 compartments in the lower leg– Each compartment holds fascia and muscleEach compartment holds fascia and muscle– Pressure becomes too great and there is no Pressure becomes too great and there is no

room for expansionroom for expansion– Vascular structures and neural structures can Vascular structures and neural structures can

be damagedbe damaged– Anterior compartment most commonly injuredAnterior compartment most commonly injured

TreatmentTreatment

Surgery must be performedSurgery must be performed A fasciotomy is performed to release A fasciotomy is performed to release

pressure in the compartmentpressure in the compartment 95% success rate95% success rate

TreatmentTreatment

Muscles invlovedMuscles invloved– Tibiallis Ant.Tibiallis Ant.– Ext. digitorum lungusExt. digitorum lungus– Ext. hallicus lungusExt. hallicus lungus

SurgerySurgery

injection Fascial release

Cut distally

Close up of cross section

Release of peroneal nerve

Surgery Cont.Surgery Cont.

Treatment Post OpTreatment Post Op

Must be place on crutches w/non-Must be place on crutches w/non-weight bearing for 7-10 daysweight bearing for 7-10 days

Friction massage by incision for soft-Friction massage by incision for soft-tissue mobilitytissue mobility

Gait trainingGait training NSAIDS NSAIDS

Goals for Post-OpGoals for Post-Op

Full ROM Full ROM Biking/Swimming 2-4 weeksBiking/Swimming 2-4 weeks

– Swimming when wound healsSwimming when wound heals Jogging at 4-6 weeksJogging at 4-6 weeks Sports participation 6-8 weeksSports participation 6-8 weeks

– Athlete should be able to run 2-3 miles Athlete should be able to run 2-3 miles pn free before returning to playpn free before returning to play

ModalitiesModalities

Milk MassageMilk Massage Myofascial releaseMyofascial release

– Release scar tissueRelease scar tissue Ice Bag/slush bucketIce Bag/slush bucket HeatHeat

– Start 3Start 3rdrd week week

Week 1Week 1

Non-weight bearingNon-weight bearing Check wound dressing dailyCheck wound dressing daily

Week 2Week 2

Partial weight-bearingPartial weight-bearing– 2 point gait2 point gait

Isometric exercisesIsometric exercises– InversionInversion– EversionEversion– Planter flexion Planter flexion – DorsiflexionDorsiflexion

Toe ExercisesToe Exercises– Towel rollsTowel rolls

Week 2 cont.Week 2 cont.

AlphabetAlphabet Weight-scale exerciseWeight-scale exercise StretchingStretching

– Gastroc stretchGastroc stretch– Soleus stretchSoleus stretch– Achilles stretchAchilles stretch– Dorsiflex stretchDorsiflex stretch

Week 3/4Week 3/4

Arm Bike/Elliptical Arm Bike/Elliptical Gait trainingGait training POOLPOOL

– Single leg stanceSingle leg stance– GrapevineGrapevine– Step upsStep ups– Gastro/soleus stretchGastro/soleus stretch– Heel raisesHeel raises

Week 3/4 Cont.Week 3/4 Cont.

Ankle WalkingAnkle Walking Double knee bendDouble knee bend Seated knee extensionSeated knee extension Team core work-outTeam core work-out

Week 5/6Week 5/6

Underwater treadmillUnderwater treadmill BAPS boardBAPS board

– Two legsTwo legs Closed kinetic chainClosed kinetic chain

– 4 Lunges4 Lunges– Squats both legsSquats both legs– Leg pressesLeg presses

Week 5/6Week 5/6

– Terminal knee ext.Terminal knee ext.– Heel raisesHeel raises

Lower leg and foot stretchesLower leg and foot stretches Rubber TubingRubber Tubing

– Inversion/eversionInversion/eversion– Plantar/dorsiflexionPlantar/dorsiflexion

Week 7/8Week 7/8

Warm up walking on treadmillWarm up walking on treadmill Stair climberStair climber Treadmill jogging ½ mile to 1 mileTreadmill jogging ½ mile to 1 mile Lower leg stretchesLower leg stretches BAPS boardBAPS board

– One legOne leg 4 Lunges w/tubing4 Lunges w/tubing Leg press-Leg press-

– More weightMore weight

Week 7/8 cont.Week 7/8 cont.

Heel raisesHeel raises Tubing exercises w/increase Tubing exercises w/increase

resistancesresistances Lunges w/tubingLunges w/tubing

Week 9/10Week 9/10 Running on the fieldRunning on the field SwimmingSwimming Box jumpingBox jumping Dot drillsDot drills Long/short passingLong/short passing Ball Juggling Ball Juggling Backwards running w/ball kickingBackwards running w/ball kicking Z-lines w/ballZ-lines w/ball Corner Kick drillsCorner Kick drills

Week 9/10Week 9/10

During last week they must pass During last week they must pass functional tests before moving to functional tests before moving to functional exercisesfunctional exercises

Must be pain freeMust be pain free Functional exerciseFunctional exercise

– ScrimmageScrimmage

PracticePractice

Return to play w/shin guardsReturn to play w/shin guards Athlete may participate in:Athlete may participate in:

– Upper Extremity Weight LiftingUpper Extremity Weight Lifting– Practice drills as tolerated w/lower ext.Practice drills as tolerated w/lower ext.– Any upper extremity drillsAny upper extremity drills– Core work outsCore work outs

ConsiderationsConsiderations

Watch for:Watch for:– Increase swellingIncrease swelling– Increase painIncrease pain– Numbness or tinglingNumbness or tingling

If any apply, modify the rehabIf any apply, modify the rehab Everything is as toleratedEverything is as tolerated

– May need to continue rehab longer than May need to continue rehab longer than expectedexpected