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82 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 1 Putting the Squeeze on Compartment Syndrome BY WHITNEY LOWE ‚ Closeup cross section of the lower leg showing tibia, fibula, and four compartments. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. technique | CLINICAL EXPLORATIONS Anterior leg pain is common for those with active lifestyles, and there are a number of conditions that can appear in this region of the body, including compartment syndrome. Compartment syndrome occurs most often in the lower leg, although other regions (such as the thigh, arm, or gluteal region, among others) can also be affected. 1 There are two forms of compartment syndrome: acute and chronic (often called exertional compartment syndrome). Recognizing acute versus chronic compartment syndrome is crucial. Chronic compartment syndromes may respond well to massage, but acute compartment syndromes are an emergency condition that need immediate care by a physician. Differentiating between a medical emergency and nonemergency is essential when the possibility of acute compartment syndrome exists. Delayed treatment on an acute compartment syndrome can cause tissue necrosis and lead to limb amputation. To understand how compartment syndromes arise, let's explore this condition. ANATOMICAL BACKGROUND The compartments in the lower leg are the most susceptible to compartment syndrome. The lower leg muscles are organized in groups containing muscles that perform similar functions. Each group is separated from the adjacent group by fascial walls, bones, or a tough interosseous membrane. These soft- and hard-tissue boundaries of each muscle group form the individual compartments. There are four compartments in the lower leg (Images 1 and 2). The anterior compartment contains the dorsiflexor muscles. The lateral compartment contains the fibularis (peroneal) muscles. The superficial posterior compartment contains the gastrocnemius and soleus (plantar flexors), while the deep posterior compartment contains the three long muscles extending into the foot: tibialis posterior, flexor hallucis longus, and flexor digitorum longus. In the lower leg, the anterior compartment is the one most susceptible to compartment syndrome. It also contains the tibial artery and vein and the deep fibular nerve (Image 3). There are also lymphatic vessels and other more superficial cutaneous nerves in the compartment. Even though some of the compartment walls are composed of fascial tissue or other soft tissue like the interosseous membrane, these tissues may be stiff and unyielding. A compartment syndrome occurs when the muscles within the compartment swell as a result of exercise or inflammation from trauma. When the muscles increase in size, the compartment must expand. If the stiff walls of the compartment don't allow it to expand sufficiently, pressure builds up from the decreasing space and growing size of the expanding muscles. As the compartment pressure increases, the contents are squeezed. A host of symptoms can result from this increased compartmental pressure.

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