Dr. Timothy K. Durnin - 8/27/2007

Question
QUESTION: My orthopedic doctor has recommended I test for Compartment Syndrome due to persistent shin pain. (previous MRIs and Bone scan showed nothing). I have since found out I'm 7 weeks pregnant and unsure how to proceed.

Is testing for compartment syndrome safe during pregnancy? (I hear it involves needles). Also, would my health be at risk if I were to wait until after delivery to begin testing? Any info is greatly appreciated - my doctor has yet to return any of my calls regarding the matter.

ANSWER: Hi Rachel,

The test involves inserting a needle with a gauge on the end to tell the current pressure, if left untreated, it can cause leg death due to necrosis or 'cutting off the blood supply'. No risk for pregnancy though, resting the leg and icing it will avoid this test. The 'treatment' is to make several longitudinal incisions down the leg to let the pressure out, leaving scars. Pretty sad since this is the 21st century. Avoid it if at all possible, I would wait until my feet were numb before doing it.

Dr. Timothy Durnin
drs.chiroweb.com

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Durnin. You mentioned it could cause leg death if left untreated. Does this occur over a period of time or could these negative effects happen in weeks, months?

I'm asking because I would like to avoid this test until after delivery. Unless of course it is absolutely necessary. I have another 8 months to go and with a toddler runnig around, I can't stay off my feet. When should I use the ice?

Thank you so very much for your reply. It brings relief to get some answers, after all the stress of phone tag with my dr.'s office.

Answer
I would first get another doctor, no physician should be unreachable. Ice should be applied to the outside of the shin with a ziplock of ice wrapped in a warm moist towel for 10 minutes every other hour. There is no exact fasciotomy 'previously described cutting' time for everyone. It varies person to person. Checking the distal pulses by the lateral malleolus 'ankle bone on outside' making sure they are there and palpable is good enough. Numbness must set in for weeks before irreparable damage can occur. I wouldn't worry too much about it until numbness sets up, icing it and taking it as easy as you can will resolve the inflammation causing the internal pressure. This of course causes the blood supply to close off, by this time you'll know it and they will free it up by letting the swelling out. The procedure isn't pretty so avoid it if possible.

Dr. Tim