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Compartment Syndrome and Muscle Hernia
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Compartment syndrome (CS)
              • Synonyms

                • Acute CS (ACS)
                • Chronic exertional CS (CECS), exertional CS, recurrent CS, subacute CS
              • Definitions

                • CS: damage to soft tissues within anatomically confined space resulting from elevated pressure within that space
                • Muscle hernia: protrusion of portion of muscle through fascia into subcutaneous tissues
                  • Usually occurs with flexion of muscle
                • Peripheral deep fascia: fascia at interface of subcutaneous tissue and muscle
                  • Superficial fascia is within subcutaneous tissue, not deep to it
                • Intermuscular deep fascia: fascia between different muscles

              IMAGING

              • General Features

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Clinite KL et al: Tibialis anterior muscle herniation in adolescents: a case series and review of the literature. Pediatr Dermatol. 36(5):664-7, 2019
                                            2. Kirchgesner T et al: Fasciae of the musculoskeletal system: MRI findings in trauma, infection and neoplastic diseases. Insights Imaging. 10(1):47, 2019
                                            3. McMillan TE et al: Diagnosing acute compartment syndrome-where have we got to? Int Orthop. 43(11):2429-35, 2019
                                            4. Flores DV et al: MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics. 38(1):124-48, 2018
                                            5. Broski SM et al: Muscle: ischemia, infarction, and compartment syndrome. Semin Musculoskelet Radiol. 21(4):443-58, 2017
                                            6. Via AG et al: Acute compartment syndrome. Muscles Ligaments Tendons J. 5(1):18-22, 2015
                                            7. von Keudell AG et al: Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 386(10000):1299-310, 2015
                                            8. Kramer DE et al: Diagnosis and management of symptomatic muscle herniation of the extremities: a retrospective review. Am J Sports Med. 41(9):2174-80, 2013
                                            9. Rajasekaran S et al: The utility of ultrasound in detecting anterior compartment thickness changes in chronic exertional compartment syndrome: a pilot study. Clin J Sport Med. 23(4):305-11, 2013
                                            10. Ringler MD et al: MRI accurately detects chronic exertional compartment syndrome: a validation study. Skeletal Radiol. 42(3):385-92, 2013
                                            11. Sigmund EE et al: Stimulated echo diffusion tensor imaging and SPAIR T(2) -weighted imaging in chronic exertional compartment syndrome of the lower leg muscles. J Magn Reson Imaging. 38(5):1073-82, 2013
                                            12. Andreisek G et al: T2*-weighted and arterial spin labeling MRI of calf muscles in healthy volunteers and patients with chronic exertional compartment syndrome: preliminary experience. AJR Am J Roentgenol. 193(4):W327-33, 2009
                                            13. Baker JF et al: Foot drop--an unusual presentation of exertional compartment syndrome. Clin J Sport Med. 19(3):236-7, 2009
                                            14. Gielen JL et al: Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI. Skeletal Radiol. 38(12):1153-61, 2009
                                            15. Liu HL et al: Gluteal compartment syndrome after prolonged immobilisation. Asian J Surg. 32(2):123-6, 2009
                                            16. McCaffrey DD et al: Acute compartment syndrome of the anterior thigh in the absence of fracture secondary to sporting trauma. J Trauma. 66(4):1238-42, 2009
                                            17. Brey JM et al: Salvage of compartment syndrome of the leg and foot. Foot Ankle Clin. 13(4):767-72, 2008
                                            18. Farr D et al: Chronic exertional compartment syndrome in a collegiate soccer player: a case report and literature review. Am J Orthop. 37(7):374-7, 2008
                                            19. Halanski M et al: Cast and splint immobilization: complications. J Am Acad Orthop Surg. 16(1):30-40, 2008
                                            20. Shadgan B et al: Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 22(8):581-7, 2008
                                            21. Dhawan SS et al: Four-extremity gangrene associated with crack cocaine abuse. Ann Emerg Med. 49(2):186-9, 2007
                                            22. Konstantakos EK et al: Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg. 73(12):1199-209, 2007
                                            23. Armfield DR et al: Sports-related muscle injury in the lower extremity. Clin Sports Med. 25(4):803-42, 2006
                                            24. Beraldo S et al: Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. 49(11):1772-80, 2006
                                            25. Woolley SL et al: Acute compartment syndrome secondary to diabetic muscle infarction: case report and literature review. Eur J Emerg Med. 13(2):113-6, 2006
                                            26. Olson SA et al: Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 13(7):436-44, 2005
                                            27. Kostler W et al: Acute compartment syndrome of the limb. Injury. 35(12):1221-7, 2004
                                            28. Pell RF 4th et al: Leg pain in the running athlete. J Am Acad Orthop Surg. 12(6):396-404, 2004
                                            29. Rominger MB et al: MR imaging of compartment syndrome of the lower leg: a case control study. Eur Radiol. 14(8):1432-9, 2004
                                            30. Beggs I: Sonography of muscle hernias. AJR Am J Roentgenol. 180(2):395-9, 2003
                                            31. Mellado JM et al: Muscle hernias of the lower leg: MRI findings. Skeletal Radiol. 28(8):465-9, 1999
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Compartment syndrome (CS)
                                                        • Synonyms

                                                          • Acute CS (ACS)
                                                          • Chronic exertional CS (CECS), exertional CS, recurrent CS, subacute CS
                                                        • Definitions

                                                          • CS: damage to soft tissues within anatomically confined space resulting from elevated pressure within that space
                                                          • Muscle hernia: protrusion of portion of muscle through fascia into subcutaneous tissues
                                                            • Usually occurs with flexion of muscle
                                                          • Peripheral deep fascia: fascia at interface of subcutaneous tissue and muscle
                                                            • Superficial fascia is within subcutaneous tissue, not deep to it
                                                          • Intermuscular deep fascia: fascia between different muscles

                                                        IMAGING

                                                        • General Features

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Clinite KL et al: Tibialis anterior muscle herniation in adolescents: a case series and review of the literature. Pediatr Dermatol. 36(5):664-7, 2019
                                                                                      2. Kirchgesner T et al: Fasciae of the musculoskeletal system: MRI findings in trauma, infection and neoplastic diseases. Insights Imaging. 10(1):47, 2019
                                                                                      3. McMillan TE et al: Diagnosing acute compartment syndrome-where have we got to? Int Orthop. 43(11):2429-35, 2019
                                                                                      4. Flores DV et al: MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics. 38(1):124-48, 2018
                                                                                      5. Broski SM et al: Muscle: ischemia, infarction, and compartment syndrome. Semin Musculoskelet Radiol. 21(4):443-58, 2017
                                                                                      6. Via AG et al: Acute compartment syndrome. Muscles Ligaments Tendons J. 5(1):18-22, 2015
                                                                                      7. von Keudell AG et al: Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 386(10000):1299-310, 2015
                                                                                      8. Kramer DE et al: Diagnosis and management of symptomatic muscle herniation of the extremities: a retrospective review. Am J Sports Med. 41(9):2174-80, 2013
                                                                                      9. Rajasekaran S et al: The utility of ultrasound in detecting anterior compartment thickness changes in chronic exertional compartment syndrome: a pilot study. Clin J Sport Med. 23(4):305-11, 2013
                                                                                      10. Ringler MD et al: MRI accurately detects chronic exertional compartment syndrome: a validation study. Skeletal Radiol. 42(3):385-92, 2013
                                                                                      11. Sigmund EE et al: Stimulated echo diffusion tensor imaging and SPAIR T(2) -weighted imaging in chronic exertional compartment syndrome of the lower leg muscles. J Magn Reson Imaging. 38(5):1073-82, 2013
                                                                                      12. Andreisek G et al: T2*-weighted and arterial spin labeling MRI of calf muscles in healthy volunteers and patients with chronic exertional compartment syndrome: preliminary experience. AJR Am J Roentgenol. 193(4):W327-33, 2009
                                                                                      13. Baker JF et al: Foot drop--an unusual presentation of exertional compartment syndrome. Clin J Sport Med. 19(3):236-7, 2009
                                                                                      14. Gielen JL et al: Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI. Skeletal Radiol. 38(12):1153-61, 2009
                                                                                      15. Liu HL et al: Gluteal compartment syndrome after prolonged immobilisation. Asian J Surg. 32(2):123-6, 2009
                                                                                      16. McCaffrey DD et al: Acute compartment syndrome of the anterior thigh in the absence of fracture secondary to sporting trauma. J Trauma. 66(4):1238-42, 2009
                                                                                      17. Brey JM et al: Salvage of compartment syndrome of the leg and foot. Foot Ankle Clin. 13(4):767-72, 2008
                                                                                      18. Farr D et al: Chronic exertional compartment syndrome in a collegiate soccer player: a case report and literature review. Am J Orthop. 37(7):374-7, 2008
                                                                                      19. Halanski M et al: Cast and splint immobilization: complications. J Am Acad Orthop Surg. 16(1):30-40, 2008
                                                                                      20. Shadgan B et al: Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 22(8):581-7, 2008
                                                                                      21. Dhawan SS et al: Four-extremity gangrene associated with crack cocaine abuse. Ann Emerg Med. 49(2):186-9, 2007
                                                                                      22. Konstantakos EK et al: Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg. 73(12):1199-209, 2007
                                                                                      23. Armfield DR et al: Sports-related muscle injury in the lower extremity. Clin Sports Med. 25(4):803-42, 2006
                                                                                      24. Beraldo S et al: Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. 49(11):1772-80, 2006
                                                                                      25. Woolley SL et al: Acute compartment syndrome secondary to diabetic muscle infarction: case report and literature review. Eur J Emerg Med. 13(2):113-6, 2006
                                                                                      26. Olson SA et al: Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 13(7):436-44, 2005
                                                                                      27. Kostler W et al: Acute compartment syndrome of the limb. Injury. 35(12):1221-7, 2004
                                                                                      28. Pell RF 4th et al: Leg pain in the running athlete. J Am Acad Orthop Surg. 12(6):396-404, 2004
                                                                                      29. Rominger MB et al: MR imaging of compartment syndrome of the lower leg: a case control study. Eur Radiol. 14(8):1432-9, 2004
                                                                                      30. Beggs I: Sonography of muscle hernias. AJR Am J Roentgenol. 180(2):395-9, 2003
                                                                                      31. Mellado JM et al: Muscle hernias of the lower leg: MRI findings. Skeletal Radiol. 28(8):465-9, 1999