Which passive movement causes pain in deep posterior compament syndrome?
Dorsiflexion of foot Compament syndrome (CS) occurs whenever increased tissue pressure in a myofascial compament compromises blood flow to the muscles and nerves within that compament, resulting in tissue and nerve damage. The compaments of the lower leg and the volar forearm are paicularly prone to developing elevated compament pressures.Two types of CS have been identified, acute and chronic.Acute CS typically occurs subsequent to a traumatic event, most commonly fractures. Symptoms worsen acutely, and irreversible nerve injury and muscle necrosis occur within hours.Chronic CS (also known as chronic exeional CS, exeional CS, recurrent CS, or subacute CS) is a recurrent syndrome that occurs with exercise or work.Relevant Anatomy There are 4 osteofascial compaments of leg enclosed by the unyielding deep fascia and separated from each other by the bones of die leg and interosseeous membrane and by the anterior and posterior intermuscular septa. Each ofthe compaments is "sealed" spaces containing muscles, aeries, and nerves.Anterior or extensor compamento Dorsiflexor muscles of the ankle and footTibialis anterior- Extensor digitorum longus- Extensor hallucis longus- Peroneus teiuso Anterior tibial aery - Commonly injured in lateral tibial plateau fractureso Deep peroneal nerve - Provides sensation to the first dorsal web spaceLateral compamento Peroneus (fibularis) brevis and peroneus (fibularis) longus - Plantar flexor and eveor muscles of the foot o Superficial peroneal nerve - Provides sensation to the dorsum of the footDeep posterior compamento Plantar flexor and phalangeal flexor muscles- Tibialis posterior- Flexor digitorum longus (FDL)- Flexor hallucis longus(and Popliteus, which acts on the,knee joint)o Posterior tibial and peroneal aerieso Posterior tibial nerve - Provides sensation to the sole of the footSuperficial posterior compamento Plantar flexor muscles of the foot- Gastrocnemius- Plantaris- Soleuso Sural nerveAcute compament syndromes are medical emergencies that may require immediate surgical treatment. Acute compament syndromes are usually the result of a traumatic incident. The swelling from the contusion causes the increased pressure in the compament. These injuries are most often seen in the emergency room and are not athletic injuries.Chronic CS is seen more often in the athletic community. Diagnosing this injury is one of exclusion. A complete examination should rule out medial tibial stress syndrome, stress fractures, and Achilles tendon injuries.The athlete presents with pain that is present during weight bearing training. Activities such as running, stair climbing, and jumping are the most common offenders.There will be pain on passive stretch of the muscles of the compament.So in the: Deep posterior compament syndrome- there will be pain on passive dorsiflexion of the foot and on toeextension (since muscles in the deep post compament are plantar flexors and phalangeal flexors )Anterior compament syndrome- there will be pain on passive plantar flexion of the foot and toe flexion.Lateral compament syndrome- there will be pain on passive foot inversion.Superficial posterior compament syndrome- pain is on passive dorsiflexion of foot.Definitive diagnosis of a chronic CS can be made with an intracompamental pressure test. A catheter is inseed into the offending compament to measure its pressure.Once the diagnosis is confirmed with a positive compament measurement, a treatment course is to be chosen. Conservative treatment is the first option. Rehabilitation should include: low impact cross training, flexibility training, appropriate strength training for weakened muscles, and/or the use of ohotics to correct biomechanical abnormalities.If conservative treatment fails, surgical intervention in the next step. Afasciotomy is the procedure of choice.
Foot abduction
Dorsiflexion of foot
Plantar flexion of foot
Foot adduction