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Anterior Compartment Syndrome

Anterior Compartment Syndrome. By Marie and Molly. History. 20 year old female soccer player Midfield Position During one of the last practice sessions of the season was kicked in the shin by another player Athlete was not wearing shin guards. Signs and Symptoms.

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Anterior Compartment Syndrome

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  1. Anterior Compartment Syndrome By Marie and Molly

  2. History • 20 year old female soccer player • Midfield Position • During one of the last practice sessions of the season was kicked in the shin by another player • Athlete was not wearing shin guards

  3. Signs and Symptoms • Pt. c/o pn w/passive plantar flexion • Pn along ant. Aspect of lower leg • Palpation reveals hardness and tension w/soft tissue • Shiny or pallor skin • Distal pulse diminished • Numbness and tingling radiating to toes

  4. Diagnosis • Pt. has Anterior Compartment Syndrome • What is it? • There are 4 compartments in the lower leg • Each compartment holds fascia and muscle • Pressure becomes too great and there is no room for expansion • Vascular structures and neural structures can be damaged • Anterior compartment most commonly injured

  5. Treatment • Surgery must be performed • A fasciotomy is performed to release pressure in the compartment • 95% success rate

  6. Treatment • Muscles invloved • Tibiallis Ant. • Ext. digitorum lungus • Ext. hallicus lungus

  7. Surgery Fascial release Cut distally injection Close up of cross section Release of peroneal nerve

  8. Surgery Cont.

  9. Treatment Post Op • Must be place on crutches w/non-weight bearing for 7-10 days • Friction massage by incision for soft-tissue mobility • Gait training • NSAIDS

  10. Goals for Post-Op • Full ROM • Biking/Swimming 2-4 weeks • Swimming when wound heals • Jogging at 4-6 weeks • Sports participation 6-8 weeks • Athlete should be able to run 2-3 miles pn free before returning to play

  11. Modalities • Milk Massage • Myofascial release • Release scar tissue • Ice Bag/slush bucket • Heat • Start 3rd week

  12. Week 1 • Non-weight bearing • Check wound dressing daily

  13. Week 2 • Partial weight-bearing • 2 point gait • Isometric exercises • Inversion • Eversion • Planter flexion • Dorsiflexion • Toe Exercises • Towel rolls

  14. Week 2 cont. • Alphabet • Weight-scale exercise • Stretching • Gastroc stretch • Soleus stretch • Achilles stretch • Dorsiflex stretch

  15. Week 3/4 • Arm Bike/Elliptical • Gait training • POOL • Single leg stance • Grapevine • Step ups • Gastro/soleus stretch • Heel raises

  16. Week 3/4 Cont. • Ankle Walking • Double knee bend • Seated knee extension • Team core work-out

  17. Week 5/6 • Underwater treadmill • BAPS board • Two legs • Closed kinetic chain • 4 Lunges • Squats both legs • Leg presses

  18. Week 5/6 • Terminal knee ext. • Heel raises • Lower leg and foot stretches • Rubber Tubing • Inversion/eversion • Plantar/dorsiflexion

  19. Week 7/8 • Warm up walking on treadmill • Stair climber • Treadmill jogging ½ mile to 1 mile • Lower leg stretches • BAPS board • One leg • 4 Lunges w/tubing • Leg press- • More weight

  20. Week 7/8 cont. • Heel raises • Tubing exercises w/increase resistances • Lunges w/tubing

  21. Week 9/10 • Running on the field • Swimming • Box jumping • Dot drills • Long/short passing • Ball Juggling • Backwards running w/ball kicking • Z-lines w/ball • Corner Kick drills

  22. Week 9/10 • During last week they must pass functional tests before moving to functional exercises • Must be pain free • Functional exercise • Scrimmage

  23. Practice • Return to play w/shin guards • Athlete may participate in: • Upper Extremity Weight Lifting • Practice drills as tolerated w/lower ext. • Any upper extremity drills • Core work outs

  24. Considerations • Watch for: • Increase swelling • Increase pain • Numbness or tingling • If any apply, modify the rehab • Everything is as tolerated • May need to continue rehab longer than expected

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