The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles

Abstract

The anterior and lateral compartmental syndromes of the leg due to intensive use of muscles can be briefly defined as painful circulatory disturbances associated with a pathological increase in total intramuscular pressure. In these syndromes, an acute and a chronic form are distinguished. The acute form takes a progressive course, and the structures within the compartment affected are subject to complete or partial destruction. The chronic form takes an intermittent course. Physical exertion of the lower limbs gives rise to pain in the compartment. Determination of the pressure in the tibialis anteriot muscle and phlebography, both before and after weighted exercise of the muscles of the anterior compartment, were found to be the most valuable diagnostic aids in the chronic syndrome. In the acute syndrome, the compartment affected must be decompressed by fasciotomy as quickly as possible. Since most patients with a chronic syndrome can adequately cope with daily requirements, an operation is not always required. Indications for fasciotomy are presented. The real cause of the increase in total intramuscular pressure is not understood, suggestions concerning the pathogenesis are made, and the mechanism of the circulatory disturbances is discussed.