COMPARTMENT SYNDROME AND SHIN SPLINTS OF THE LOWER LEG

Objectives: The objective of this article is to review and categorize the current knowledge on compartment syndromes (CS) and shin splints ( SS), with specific importance relegated to the diagnosis, differential diagnosis and management of these conditions. Data Sources: The bibli ographic data sources reviewed are limited to the English language and human content and are from medical and scientific journals, as well a s chiropractic and medical texts. A mini-Medline version of Index Medi cus was utilized. Terms for indexing included compartment syndromes, s hin splints and stress fractures. The bibliographies of the journals s elected were then evaluated and, where appropriate, the specific journ al or text references regarding diagnosis and management were then rev iewed. This information was then included in this article, where usefu l, to further clarify or reference statements made. Conclusion: Differ ential diagnosis of the acute CS from chronic CS and SS requires clini cal methods and imaging procedures. The pathogenesis of the acute CS o f the lower leg is associated with external pressure or internal hemor rhage. If the tissue pressure were to rise above 30-40 mm Hg for 4-12 h, irreversible muscular damage would result. Emergency surgical inter vention is the only appropriate form of treatment in acute CS. In chro nic CS, where elevated pressures exist on a transient basis, influence d by activity, conservative management procedures are felt to be effec tive. However, if these methods are not helpful, surgical intervention may be necessary. The etiology of pain associated with SS is not asso ciated with compartmental pressure elevations, but rather. results fro m periostitis occurring along the tibia caused by muscular and tendino us strain associated with inflammation. Conservative management is mos t appropriate for this disorder, with surgical intervention being an u ncommon treatment approach. Although clinical findings are useful in t he diagnosis of these disorders, fluid pressure findings may be necess ary to fully differentiate acute CS from other disorders. Up until rec ently, common methods of obtaining pressure measurements of compartmen ts included the use of a needle manometer. More recently, however, a h and-held miniature fluid pressure monitor has been developed that prod uces reproducible measurements of interstitial fluid, making testing p otentially practical for the clinician.