Compartment Syndrome
Compartment syndrome is a painful condition that occurs when pressure within a body compartment (most typically, an extremity) increases to the point that it restricts the blood flow to muscles, nerves, and/or other tissue in and more distal to that compartment. In other words, a compartment syndrome occurs when area of the body bordered and defined by rigid or near-rigid (i.e., non-stretchable) structures develops within it an increase in pressure due to excess fluid or swelling. Compartments are groupings of muscles, nerves, and blood vessels in the arms and legs. They are surrounded by connective tissue called fascia, which does not stretch easily. Acute compartment syndrome can develop a few hours or faster after an injury to an arm or leg. Compartment syndrome is a medical emergency requiring immediate treatment to avoid permanent damage.
In trauma, this is most commonly from swelling and/or bleeding. The rigid or near-rigid structures are most commonly bone and/or fascia, the connective tissue that encircles organs, muscles, body cavities, etc. Even a small amount of swelling and/or bleeding in a compartment that cannot expand can cause permanent damage or death to the tissue, muscles, blood vessels, and nerves within it/passing through it. Left untreated, compartment syndrome can also cause death of the patient.
Persistent, severe lower extremity pain uncontrolled by medication, increasing pain upon movement of the toes, and pain that is disproportionate to the situation/injury, are classic signs of a developing lower extremity compartment syndrome, which, again is a medical emergency.
Because the deep fibular/peroneal nerve passes through the anterior lower extremity compartment, the area is susceptible to severe and permanent damage from a compartment syndrome. Injury to this nerve can result in the inability to dorsiflex (i.e., move the superior (top) part of the foot toward the shin), a condition known as foot drop, which, in turn, damages gait.
The treatment is relatively straightforward: fasciotomy, which is simply the surgical cutting of the fascia (wrapping) to allow the materials within to expand temporarily to allow the offending swelling and/or bleeding to abate and/or, in the case of a hematoma (collection of blood), be removed.
Compartment syndrome medical expert witness specialties include orthopaedic surgery, emergency medicine, pediatric emergency medicine, urgent care, pediatric orthopaedic surgery, vascular surgery, general surgery, neurology, podiatry, and hematology.