Acute Exertional Compartment Syndrome with Rhabdomyloysis: Case Report and Review of Literature
August 31, 2020
The ability for a clinician to promptly diagnose and initiate proper treatment for acute exertional compartment syndrome (AECS) is crucial for the prevention of severe or devastating consequences for the patient.
Acute exertional compartment syndrome (AECS) is characterized by a rise in pressure within a closed fascial space in the absence of a specific traumatic event. In comparison to chronic exertional compartment syndrome (CECS) ACES is a surgical emergency. Although, clinicians are aware of the potential for acute compartment syndrome in fractures, there has been limited awareness directed towards the risk of acute compartment syndrome in a non-fracture and non-traumatic presentation. Therefore, the diagnosis is often delayed. A delayed diagnosis concludes in muscle necrosis and neurovascular injury. It is critical for clinicians to maintain a high index of suspicion for AECS in patients with acute presentations of non-fracture atraumatic limb pain.
Brief Case Description
This study reports a 17-year-old healthy, male, African American, high school football player that presented to the emergency department with the sub acute onset of right leg pain and the inability to dorsiflex his foot. Due to the increased pressure within his leg, compartment pressure measurements were performed using the STIC Intra-Compartmental Pressure Monitor (C2Dx). The patients anterior compartment measured 54 mmHg, when using the 30-mmHg threshold. The patient was diagnosed following clinical measurements with acute exertional compartment syndrome in the anterior compartment of the right leg (with rhabdomyolysis).
Intervention and Outcome Summary
The occurrence of acute compartment syndrome in the absence of trauma or fracture, though rare, can have devastating consequences following delays in treatment. Similar to fracture related acute compartment syndrome, acute exertional compartment syndrome requires prompt diagnosis and surgical intervention to prevent these consequences. Diagnosis of atraumatic cases can be difficult, which is why awareness is equally as important as history and physical examination. While diagnosis is primarily clinical, it can be supported with direct intra-compartmental pressure measurements and maintaining a high index of suspicion in acute presentations of exertional limb pain.
The American Journal of Case Reports
Brandon McKinney, Christopher Gaunder, Ross Schumer