Mixed Compartment Syndromes and Neuropathy Resolution With Hyperbaric Oxygen

Skeletal muscle compartment syndrome (SMCS) and exertional compartment syndrome (ECS) are two distinct conditions. This case report describes a situation in which both conditions resulted from the same triggering events. The importance of this case lies in the fact that the residual neuropathy associated with the SMCS resolved after a single hyperbaric oxygen (HBO₂) treatment.

This report was generated from a retrospective analysis of the patient's combined compartment syndromes, SMCS and ECS, residual functional deficit, and resolution of the latter with HBO₂ treatment. Severe leg pain developed after two strenuous back-to-back ballet and gymnastics sessions. Similar leg pains of lesser severity had occurred previously but always resolved after the activity was stopped. During this episode, the pain subsided; however, the next day, the patient began to walk with a steppage gait. The athlete received HBO₂ treatment, which restored her peroneal nerve function. Subsequently, the patient underwent an ECS evaluation, bilateral leg fasciotomies, and returned to athletic activities without symptoms.

A residual nerve palsy can result from an SMCS. This symptom, combined with the rapid resolution of pain symptoms consistent with an ECS, suggests that both problems resulted from the same cause. The delayed onset of the drop foot was attributed to the self-perpetuating cycle of ischemia and edema associated with the lag phase of the SMCS. The resolution of the peroneal nerve palsy with HBO₂ treatment adds additional validation for the roles of HBO₂ in SMCS.