Acute Exertional Compartment Syndrome with Rhabdomyolysis: Case Report and Review of Literature

Abstract

Patient: Male, 17Final Diagnosis: Acute exertional compartment syndromeSymptoms: Foot drop • leg pain • paresthesiaMedication: —Clinical Procedure: FasciotomySpecialty: Orthopedics and TraumatologyObjective:Rare diseaseBackground:Acute exertional compartment syndrome (AECS) is a rare cause of leg pain often associated with a delay in diagnosis and potentially leading to irreversible muscle and nerve damage.Case Report:We present the case of a previously healthy, high-level athlete who presented with the acute onset of unilateral anterior leg pain and foot drop the day after a strenuous workout. He was diagnosed with compartment syndrome and rhabdomyolysis. His management included emergent fluid resuscitation, fasciotomies, debridement of necrotic muscle from his anterior compartment, and delayed primary closure. After six months of intensive outpatient physical therapy, including the use of blood flow restriction treatments, the patient returned to sports and received a NCAA Division I Football scholarship.Conclusions:We describe the details of this patient’s case and review the literature related to acute exertional compartment syndrome. The occurrence of acute compartment syndrome in the absence of trauma or fracture, though rare, can have devastating consequences following delays in treatment. AECS 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.

Case reports of athletes affected by rhabdomyolysis: A systematic review

“…Of the 126 studies found through the search strategy, 10 met the proposed inclusion criteria and were in compliance with the CARE recommendations.Of the 10 articles selected to compose the present review, two reported cases of soccer athletes, 23,25 three of football, 17,19,21 two of swimming, 22,24 one of wrestling, 20 one of 24-hour cross-country skiing, 18 and one of mixed martial arts (MMA). 26 Of the six modalities described in the studies, four presented characteristics of physical contact sports (soccer, football, wrestling, and MMA) and two were related to individuals sports (skiing and swimming).The age range of the athletes varied between 16 to 41 years old.…”

“…Acute exertional compartment syndrome with rhabdomyolysis: case report and review of literature - McKinney et al., 2018. 17…”

Unusual Presentation of Compartment Syndrome

“…However, in Livingston's series, despite the high average intracompartmental pressures measured (91 mm Hg), there was no correlation between pressure and muscle damage, but a strong correlation of a time to diagnose more than 24 hours and myonecrosis is evident. This year, McKinney et al reported a case of AECS affecting the anterior tibial compartment presenting with foot drop which was successfully treated with anterior lateral fasciotomies and rhabdomyolysis-supportive treatment, giving him full recovery apart from inability to extend of his hallux due to EHL necrosis [6]. Nicholson et al reported AECS of the peroneal compartment on a 24-year-old healthy female after prolonged horse riding [7].…”

Lower Extremity Compartment Syndrome in National Football League Athletes

“…12 Acute compartment syndrome (ACS) can result from direct impact injuries to soft tissue structures, ischemia related to vascular injury, extremity fractures, or more rarely, overexertion. 12,15,24 Acute exertional compartment syndrome (AECS) is a rare subset of ACS, characterized by an increase in intracompartmental pressure without a specific traumatic event. 15,24 The lower leg is composed of 4 compartments: anterior, lateral, superficial posterior, and deep posterior.…”

“…12,15,24 Acute exertional compartment syndrome (AECS) is a rare subset of ACS, characterized by an increase in intracompartmental pressure without a specific traumatic event. 15,24 The lower leg is composed of 4 compartments: anterior, lateral, superficial posterior, and deep posterior. 8 Pain with passive stretch of the muscles within the affected compartment(s) is a hallmark of early clinical diagnosis prior to the onset of sensory or motor changes.…”