A Case Report of Acute Exertional Compartment Syndrome with Peroneal Nerve Palsy in an Adolescent Athlete
September 18, 2020
Compartment syndrome is a dangerous and potentially disastrous condition for a patient, which if not treated in a timely fashion can have devastating consequences. If there is high clinical suspicion of compartment syndrome intra-compartmental pressure should be measured immediately using a STIC intra-compartmental pressure monitor to confirm the proper diagnosis and assist in data-driven decisions.
Acute compartment syndrome (ACS) following chronic exertional compartment syndrome is a known but uncommon complication in many athletes and its profile remains unclear to date. Failure to recognize compartment syndrome and promptly treat this condition can lead to disastrous sequelae. Unlike chronic exertional compartment syndrome, acute compartment syndrome is unrelieved by rest and causes severe unrelenting pain. It commonly occurs after intense, prolonged exercise.
Brief Case Description
This case presents the case of a 13-year-old lacrosse player with a history of Chronic Exertional Compartment Syndrome (CECS) who developed unprovoked acute compartment syndrome. Despite an emergent fasciotomy, the patient experienced intermittent episodes of peroneal nerve deficits. A peroneal nerve neurolysis was later performed which resulted in full resolution of her symptoms. This case enhances the importance of acknowledging a high index of suspicion for compartment syndrome which if not treated in a timely fashion can result in devastating consequences including nerve deficits.
Intervention and Outcome Summary
Due to the athlete’s significant pain increase with a persistent foot drop and a cool leg in absence of a clear etiology, she had presented to the hospital immediately following. She was sent to the emergency room for an evaluation of acute compartment syndrome. In the emergency room, the patient was tested for compartment syndrome using a Hand-Held STIC Compartment Pressure Monitor. The patient was diagnosed with compartment syndrome as her intra-compartmental pressures measured at 51 mm Hg in the anterior compartment and 45 mm in the lateral compartment. Immediately, the patient was transferred to the operating room for an anterior and lateral compartment fasciotomy along with a muscle biopsy of the anterior compartment. Surgical intervention is critical for any patient suffering from acute compartment syndrome. A timely diagnosis and treatment are of the utmost importance as well. There have been multiple clinical based studies that have proven the relationship between increased duration and pressures with increasing debilitation. To note, only eight percent of patients regain full function when a delay of fasciotomy is delayed over 12 hours. Matsen et al. demonstrated that irreversible damage to nervous tissue could occur after 6 to 12 hours of elevated compartment pressures.
Journal of Orthopaedic Case Reports
Andrew Jimenez, Barton R Branam, Kimberly A Hasselfeld, Kathryn A Hasselfeld