Compartment syndrome and shin splints of the lower leg.

OBJECTIVES: The objective of this article is to review and categorize the current knowledge on compartment syndromes (CS) and shin splints (SS), with specific importance relegated to the diagnosis, differential diagnosis and management of these conditions. DATA SOURCES: The bibliographic data sources reviewed are limited to the English language and human content and are from medical and scientific journals, as well as chiropractic and medical texts. A mini-Medline version of Index Medicus was utilized. Terms for indexing included compartment syndromes, shin splints and stress fractures. The bibliographies of the journals selected were then evaluated and, where appropriate, the specific journal or text references regarding diagnosis and management were then reviewed. This information was then included in this article, where useful, to further clarify or reference statements made. CONCLUSION: Differential diagnosis of the acute CS from chronic CS and SS requires clinical methods and imaging procedures. The pathogenesis of the acute CS of the lower leg is associated with external pressure or internal hemorrhage. If the tissue pressure were to rise above 30-40 mm Hg for 4-12 h, irreversible muscular damage would result. Emergency surgical intervention is the only appropriate form of treatment in acute CS. In chronic CS, where elevated pressures exist on a transient basis, influenced by activity, conservative management procedures are felt to be effective. However, if these methods are not helpful, surgical intervention may be necessary. The etiology of pain associated with SS is not associated with compartmental pressure elevations, but rather, results from periostitis occurring along the tibia caused by muscular and tendinous strain associated with inflammation. Conservative management is most appropriate for this disorder, with surgical intervention being an uncommon treatment approach. Although clinical findings are useful in the diagnosis of these disorders, fluid pressure findings may be necessary to fully differentiate acute CS from other disorders. Up until recently, common methods of obtaining pressure measurements of compartments included the use of a needle manometer. More recently, however, a hand-held miniature fluid pressure monitor has been developed that produces reproducible measurements of interstitial fluid, making testing potentially practical for the clinician.

Chronic fatigue syndrome.

A 36-yr-old white female presented with severe fatigue and symptoms consistent with immune deficiency, but was later found to be suffering from chronic fatigue syndrome. This article discusses the diagnostic criteria for this condition. Chiropractic manipulation afforded relief of some symptoms for this patient.

Thermographic evaluation of rats with complete sciatic nerve transection.

Although numerous clinical thermographic studies are available, few basic science studies using thermography have been performed. As such, evidence suggesting the diagnostic use of thermography is often mired in the complexity of human ailments. This study thermographically evaluated the hind paws of rats. Rats acted as their own controls using the contralateral side as reference. Rats were separated into two groups: sham operated rats and rats with complete sciatic nerve transection. Rats that received sciatic transection were noted to have a 5.1 degrees C rise of the affected plantar hind paw immediately following transection. There was a statistical difference in right vs. left up to 42 days, and a return to symmetry at 63 days. The sham operated group did not experience a rise in temperature of the affected hind paw. Controlled animal studies of this type may be an aid in understanding clinical thermography.

Avascular necrosis of the femur head.

A case of avascular necrosis of the femur head is presented. Its clinical picture is similar to that of osteoarthritis of the hip. The examination should include plain film radiography and radionuclide scan. When these two imaging procedures are equivocal, then magnetic resonance imaging should be considered. The therapy is often core decompression or total hip replacement, while conservative care is rarely indicated.

Osseous configurations of the axial skeleton: specific application to spatial relationships of vertebrae.

Traditionally, the chiropractic profession has employed two different methods to describe spatial relationships (i.e., listings) of subluxated vertebrae for corrective orientation purposes. These methods (Palmer- Gonstead - Firth and Diversified), in addition to being somewhat limited in their scope of application, do result in some confusion. This paper, therefore, proposes a new method designating vertebral position and movement based on the "right-handed orthogonal coordinate system" of White, Panjabi and others.