eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Compartment Syndrome: Differential Diagnoses & Workup

Author: Abraham T Rasul Jr, MD, Medical Director for Rehabilitation, Specialty Hospital of Washington; Medical Director for Rehabilitation, St Thomas More Medical Complex; Founder, Arizona Golf Medicine Institute
Contributor Information and Disclosures

Updated: Mar 11, 2009

Differential Diagnoses

Stress Fracture

Other Problems to Be Considered

Also consider periostitis (ie, shin splints) when entertaining the possible diagnosis of chronic compartment syndrome.

Workup

Laboratory Studies

  • Additional workup is needed to rule out other associated pain-producing pathologies in the leg.
  • With acute compartment syndrome, especially with trauma, consider obtaining workup for rhabdomyolysis (ie, creatine phosphokinase [CPK], renal functions, urinalysis, urine myoglobin).

Imaging Studies

  • Stress fractures and periostitis can be diagnosed with plain radiographs, bone scans, computed tomography (CT) scans, or magnetic resonance images.14
  • Vascular pathologies can be evaluated with arterial and venous Doppler ultrasonography. In some cases, a venogram or arteriogram may be necessary.
  • Muscle tears can be observed using magnetic resonance imaging (MRI) or ultrasonography.15

Other Tests

  • Measurement of compartment pressures, as mentioned earlier
  • Nerve conduction studies are needed to evaluate nerve entrapment syndromes.

Procedures

  • In unusual cases, muscle biopsies may be necessary in primary muscle disorders.

More on Compartment Syndrome

Overview: Compartment Syndrome
Differential Diagnoses & Workup: Compartment Syndrome
Treatment & Medication: Compartment Syndrome
Follow-up: Compartment Syndrome
References
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References

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  2. Amendala A, Rorabeck CH. Chronic exertional compartment syndrome. In: Welsh RP, Shepard RJ, eds. Current Therapy in Sports Medicine. 1985. Toronto, Canada: BC Decker; 250-2.

  3. Blackman P, Bradshaw C, Crossley K. Chronic exertional compartment syndrome in the lower leg. A comparison of treatment options and outcome. International Conference of Science and Medicine in Sports, Brisbane, Australia. 1994;56-7.

  4. Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. Mar 2000;32(3 Suppl):S4-10. [Medline].

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  6. Howard JL, Mohtadi NG, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sport Med. Jul 2000;10(3):176-84. [Medline].

  7. Liem NR, Bourque PR, Michaud C. Acute exertional compartment syndrome in the setting of anabolic steroids: an unusual cause of bilateral footdrop. Muscle Nerve. Jul 2005;32(1):113-7. [Medline].

  8. Mouhsine E, Garofalo R, Moretti B, et al. Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. Feb 2006;14(2):193-7. [Medline].

  9. Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg. Long-term followup. Am J Sports Med. Nov-Dec 1993;21(6):811-7; discussion 817. [Medline].

  10. Wallensten R, Karlsson J. Histochemical and metabolic changes in lower leg muscles in exercise- induced pain. Int J Sports Med. Aug 1984;5(4):202-8. [Medline].

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  12. Bleicher RJ, Sherman HF, Latenser BA. Bilateral gluteal compartment syndrome. J Trauma. Jan 1997;42(1):118-22. [Medline].

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  14. Reach JS Jr, Amrami KK, Felmlee JP, et al. The compartments of the foot: a 3-tesla magnetic resonance imaging study with clinical correlates for needle pressure testing. Foot Ankle Int. May 2007;28(5):584-94. [Medline].

  15. Yu JS, Habib P. MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. Jan 9 2009;[Medline].

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  17. Pollak AN. Use of negative pressure wound therapy with reticulated open cell foam for lower extremity trauma. J Orthop Trauma. Nov-Dec 2008;22(10 Suppl):S142-5. [Medline].

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  21. Frezza EE. The lithotomy versus the supine position for laparoscopic advanced surgeries: a historical review. J Laparoendosc Adv Surg Tech A. Apr 2005;15(2):140-4. [Medline].

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  23. Phillips JH, Mackinnon SE, Beatty SE, et al. Vibratory sensory testing in acute compartment syndromes: a clinical and experimental study. Plast Reconstr Surg. May 1987;79(5):796-801. [Medline].

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  25. Snyder BJ, Oliva A, Buncke HJ. Calcific myonecrosis following compartment syndrome: report of two cases, review of the literature, and recommendations for treatment. J Trauma. Oct 1995;39(4):792-5. [Medline].

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Further Reading

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Keywords

compartment syndrome, fasciotomy, anterior compartment syndrome, compartmental syndrome, acute compartment syndrome, exertional compartment syndrome, compartment pressure, intracompartmental pressure

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Contributor Information and Disclosures

Author

Abraham T Rasul Jr, MD, Medical Director for Rehabilitation, Specialty Hospital of Washington; Medical Director for Rehabilitation, St Thomas More Medical Complex; Founder, Arizona Golf Medicine Institute
Abraham T Rasul Jr, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Rajesh R Yadav, MD, Assistant Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas at Houston
Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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