Compartment syndrome and shin splints of the lower leg

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.

The bibliographic data sources reviewed are limited to the English language and human content and are from medical and scientific journals, as well as chiropractic and medical texts. A mini-Medline version of Index Medicus was utilized. Terms for indexing included compartment syndromes, shin splints and stress fractures. The bibliographies of the journals selected were then evaluated and, where appropriate, the specific journal or text references regarding diagnosis and management were then reviewed. This information was then included in this article, where useful, to further clarify or reference statements made.

Differential diagnosis of the acute CS from chronic CS and SS requires clinical methods and imaging procedures. The pathogenesis of the acute CS of the lower leg is associated with external pressure or internal hemorrhage. If the tissue pressure were to rise above 30-40 mm Hg for 4-12 h, irreversible muscular damage would result. Emergency surgical intervention is the only appropriate form of treatment in acute CS. In chronic CS, where elevated pressures exist on a transient basis, influenced by activity, conservative management procedures are felt to be effective. However, if these methods are not helpful, surgical intervention may be necessary. The etiology of pain associated with SS is not associated with compartmental pressure elevations, but rather, results from periostitis occurring along the tibia caused by muscular and tendinous strain associated with inflammation. Conservative management is most appropriate for this disorder, with surgical intervention being an uncommon treatment approach. Although clinical findings are useful in the diagnosis of these disorders, fluid pressure findings may be necessary to fully differentiate acute CS from other disorders. Up until recently, common methods of obtaining pressure measurements of compartments included the use of a needle manometer. More recently, however, a hand-held miniature fluid pressure monitor has been developed that produces reproducible measurements of interstitial fluid, making testing potentially practical for the clinician.