Case Study: Leg Pain

Question 1

Differential Diagnosis “Shin Splints”

Answer 1

• Stress fractures
• Medial tibial syndrome
• Compartment syndromes

Anterior

Deep Posterior

Question 2

•Occurs when muscles become fatigued and unable to absorb shock. Muscle overload shock is transferred to weight bearing bones

Answer 2

stress fractures

Question 3

Stress fractures are _______ injury

Answer 3

overuse

Question 4

Stress fractures most occur in __________

Answer 4

bones of lower leg and foot

Question 5

Sxs stress fractures

Answer 5

pain w/ activity, subsides w/ rest

Question 6

STress fractures dx

Answer 6

xray, MRI, bone scan

Question 7

stress fractures tx

Answer 7

rest

Question 8

Medial Tibial Syndrome

• Most common site is ______ of the _____ border of the _____
• Generally felt to be the insertion of the _____
• Pathology is an area of _______

Answer 8

• Most common site is distal one-third of the medial border of the tibia
• Generally felt to be the insertion of the soleus
• Pathology is an area of tibial periostitis

Question 9

Medial Tibial Syndrome Dx

Answer 9

•physical exam, pain on palpation of the distal tibia over a length of 5 cm.

Question 10

Medial tibial syndrome tx

Answer 10

rest

Question 11

A condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space.

Answer 11

Compartment syndrome

Question 12

Compartment syndrome complications

Answer 12

• Reduces tissue perfusion - ischemia
• Results in cell death - necrosis
• True Orthopedic Emergency

Question 13

Compartment Syndrome Etiology

Answer 13

• Fractures-closed and open
• Blunt trauma
• Cast/dressing
• Burns/electrical
• Exertional states
• Gunshot
• IV/A-lines
• Hemophiliac/coag
• Intraosseous IV(infant)
• Snake bite
• Arterial injury

Question 14

Most common cause of compartment syndrome

Answer 14

Fracture (incidence of accompanying CS 9.1%)

Question 15

CS incidence is directly proportional to the __________

Answer 15

degree of injury to soft tissue and bone (fracture)

Question 16

Most common fracture occurence –> CS

Answer 16

•occurred most often in association with a comminuted, grade-III open injury to a pedestrian

Question 17

2nd most common cause of CS

Answer 17

blunt trauma (about 23% of CS)

25% d/t direct blow

Question 18

CS tissue survival

Answer 18

•Muscle

– 3-4 hours - reversible changes

–6 hours - variable damage

–8 hours - irreversible changes

•Nerve

–2 hours - looses nerve conduction

–4 hours - neuropraxia

–8 hours - irreversible changes

Question 19

CS dx

Answer 19

• Pain out of proportion
• Palpably tense compartment
• Pain with passive stretch
• Paresthesia/hypoesthesia
• Paralysis
• Pulselessness/pallor

Question 20

CS pain

Answer 20

most important. Especially pain out of proportion to the injury (child becoming more and more restless /needing more analgesia)

Pain on passive stretching and palpation of involved compartment

Question 22

CS Pain vs other Ps

Answer 22

•Other features like pallor, pulselessness, paralysis, paraesthesia etc. appear very late and we should not wait for these things.

Question 23

CS tx

Answer 23

fasciotomy - all compartments

Question 24

CS wound management

Answer 24

• After the fasciotomy, a bulky compression dressing and a splint are applied.
• Incision for the fasciotomy usually can be closed after three to five days

Question 25

Medial tibial syndrome is from the insertion of the:

Answer 25

soleus

Question 26

The initial treatment of compartment syndrome is:

Answer 26

Fasciotomy