Compartment syndrome (CS) occurs when pressure builds up in a closed space in a dog’s body, such as the forearm, leg, thigh, or buttock. This can lead to muscle and nerve damage due to rise of tension within the compartment. The resulting decreased perfusion of the muscle can lead to edema, ischemia and cell death.
This often occurs due to trauma in the form of a crush injury which can lead to severe systemic compromise such as acute kidney injury (AKI) or possibly death if treatment is not initiated in a timely manner. The systemic involvement is due to the release of muscle cell contents into circulation – often associated with rhabdomyolysis.
Reports of crush injury or compartment syndrome are scarce in the veterinary literature. Most of the understanding regarding the pathophysiology and treatment recommendations is extrapolated from human cases.
Diagnosis may be suspected by the “5 P’s” (pain, pallor (pale or whitish appearance of the skin), paresthesia, pulselessness in the affected extremity, and paralysis). Direct intracompartment pressure measurement can also be performed. Your pet may have dark, tea-colored urine secondary to myoglobinuria. Rhabdomyolysis frequently will cause an elevated serum creatine kinase on bloodwork. Electrolytes should be measured as soon as possible, in particular potassium.
In chronic tears, there is small damage that occurs without sufficient healing leading to more damage. This is referred to as achillodynia. Achillodynia can eventually lead to a complete rupture. In acute injuries we see a disruption of the tendon that ranges from mild to a complete rupture. A history of trauma may be present such as a jumping down, lunging, or a laceration.
Diagnosis is generally based on the above clinical signs/symptoms. We would recommend bloodwork and possibly musculoskeletal ultrasound to aid in diagnosing.
Surgical decompression, usually by fasciotomy (surgeon cuts open the skin and compartment to relieve pressure), is the definitive treatment while restoring perfusion (blood flow) to the affected muscle tissues.
Most proposed human protocols also include goals to correct hypovolemia, correct any acid-base or electrolyte disturbances and prevent acute kidney injury.
Physical therapy for Compartment Syndrome focuses heavily on massage techniques to the affected tissues. We use ultrasound, heat, laser therapy, massage, and stretching to try to heal and bring in blood flow to the tissue. We also address any secondary pain or swelling that may be associated with the trauma. Our goal is to help provide pain control first followed by relaxation to areas of compensation followed by strengthening exercises to help regain overall mobility.
