Calf Muscle pain causes and treatments some time due to CHRONIC EXERTIONAL COMPARTMENT SYNDROME
History of calf muscle pain causes and treatments
■ Definition: ache, sharp pain, or pressure in the lower leg experienced during sporting activity, usually relieved at rest
■ Most commonly anterior compartment but may occur in all
■ Usually nontender on exam
■ No history of trauma
■ Common in runners or any athletes with high demands placed on their lower extremities
■ 75–95% have symptoms bilaterally
■ Etiology unclear
Pathogenesis
■ Pressure elevation due to muscle hypertrophy or noncompliant fascia causing pain by direct mechanical deformation of pain fibers
■ Muscle injury: edema/hemorrhage – increased pressure in enclosed space – ischemia – further soft tissue damage
Physical exam calf muscle pain causes and treatments
■ Often have negative exams in the office
■ Possible tenderness or increased tension over involved compartment after exercise
■ Passive stretching of involved compartment may induce pain after exercise
■ Reduced sensation over first dorsal web space with involvement of deep peroneal nerve
■ Weakness or paresthesias may also occur with chronic cases studies
■ Compartment pressure measurement
➣ Direct measurement of involved compartments using needle catheter such as Stryker STIC catheter, WICK catheter, or transducer from arterial line
➣ Operative treatment: fasciotomy recommended with a measured pressure > 15 mmHg at rest, > 30 mmHg after 1 min exercise or 20 mmHg after 5 minutes after exercise
58 Chronic Exertional Compartment Syndrome
Differential diagnosis
■ Stress fracture
■ Periostitis
■ Tendinitis
■ Nerve entrapment
■ Infection
■ Neoplasm
■ Venous stasis
■ Excessive pronation
Treatment of Calf Muscle pain causes and treatments
■ Nonoperative
➣ Activity modification
➣ Orthotics
➣ Generally unsuccessful
➣ Compartment measurements if clinically suspicious
■ Operative
➣ Anterior compartment is usually the only decompression necessary.
➣ Anterior compartment release: 2- to 3-cm incision off the tibial crest
➣ Careful of superficial peroneal nerve as it exits the fascia approximately 10 cm above fibula
➣ Additional compartment release as clinically necessary disposition
N/A
Prognosis
■ Good if recognized and treated early
■ Persistent weakness or nerve damage can occur in chronic untreated cases.
Caveats and pearls
■ Early recognition is the key to successful treatment.
■ Always consider exertional compartment syndrome in cases of
vague lower extremity pain in athletes.
Joint Dislocation/subluxation, Complications in joint Dislocation/subluxation