Peripheral nerve entrapment and compartment syndromes of the lower leg

Peripheral nerve injuries are quite rare in the athlete, accounting for less than 1% of sporting injuries.1^-4 Nevertheless, they can be a career-ending event for the athlete and have ramifications for many functional activities outside of sports. Therefore, it is imperative that nerve involvement be diagnosed promptly, allowing early intervention prior to irreversible loss of nerve function. Sports medicine physicians must have an in-depth knowledge of peripheral nerve anatomy and physiology to diagnose the level of injury accurately and provide appropriate treatment and prognostic information to the athlete. The diagnosis is primarily based on the history, physical examination, and electrodiagnostic testing. Treatment is usually conservative and can include relative rest, technique modification, physical therapy, antiinflammatory medication, splinting, and steroid injection. Occasionally, surgical decompression or reconstruction is necessary. Similarly, compartment syndromes in the athlete can have a major impact on performance, often limiting participation in the case of exertional compartment syndrome or causing irreparable loss of function in the case of acute compartment syndrome. Exertional compartment syndromes can be difficult to diagnose and may masquerade as a peripheral nerve injury because of the associated neural compression that occurs with increased compartment pressures. One must maintain a high index of suspicion and pursue a definitive diagnosis, including measurement of compartment pressures, to diagnose this condition in a timely manner. This chapter discusses nerve entrapment and compartment syndromes in the leg, reviewing the anatomy, mechanisms of injury, clinical presentation, evaluation, treatment, and prevention.