Diagnosis | Compartment syndrome of the lower leg

Diagnosis

The diagnosis of acute compartment syndrome is based on the clinical symptoms. The diagnosis and therapeutic decision are made very generously in this clinical picture, since the disease quickly takes a dangerous course and at a certain point cannot be compensated by the body itself. A typical accident with compression of the lower leg or a recent operation together with the symptoms are sufficient criteria to initiate surgical treatment.

The examination of the lower leg should include an external inspection and palpation of the lower leg if the pain is bearable. In the case of a clear compartment syndrome, a hardening and increase in pressure can already be palpated. Intraoperatively, the exact pressure in the musculature can be measured by means of a probe if the situation is unclear.

How is a measurement performed?

The measurement must be performed under sterile conditions. For this purpose special probes are used, which can indicate the pressure exactly. The probe can be placed invasively under the fascia of the affected musculature and measure the pressure directly in the compartment.

The exact position should be checked using ultrasound. The measurement can be a further indicator for surgery. The measurement can also be performed in chronic compartment syndrome, even under stress. This allows the exact extent and potential damage to nerves, veins and arteries to be estimated.

These symptoms indicate a compartment syndrome on the lower leg

The typical main symptom of compartment syndrome is pain. It occurs spontaneously and suddenly and is located in the muscle. The pain can increase when the muscle is moved, stretched or tensed.Later, muscle weakness, sensitivity disorders and tingling follow, which indicates that damage to the nerves and arteries is already taking place.

The swelling and tension can also be felt externally in the form of hardening. The skin of the shinbone or calf can be visibly tense and shiny. Depending on the cause, external red and blue hematomas or fresh operation scars can be seen.

Overall, a slight external swelling of the entire lower leg can also be detected. The compartment syndrome occurs most frequently on the shin. The compartment syndrome can occur in the tibia’s musculature in a favored manner on the one hand, but on the other hand it can have particularly devastating consequences.

This is also where the nerves and large arteries of this muscle group run, which are primarily responsible for lifting the foot and toes. In addition to the acute compartment syndrome, a chronic course can also occur in this muscle group. In this case, the affected persons often first notice swelling and pain while walking.

Since this is a rapidly progressing disease with a high potential of long-term damage to various structures, surgery must be performed quickly in most cases. The calf is significantly less frequently affected by compartment syndrome than the muscle group on the shin. The calf as a whole is composed of a larger proportion of soft tissue and contains several muscle groups.

The difficulty in diagnostics is to identify the causal muscle group, as both superficial and deep lying logs can be responsible. If the nerve that runs in the calf is also involved, there may also be restrictions in the bending of the foot downwards and in the rotation of the lower ankle joint. Accurate measurement of pressure within the fascia is difficult in deep compartment syndromes. This is also a highly acute disease, which is why the diagnosis and indication for surgery are given generously.