Persistent pain, swelling could be worse than you think

HEALTH WATCH: MIKEL JACKSON 

   A couple weeks ago, a coach friend of mine told me about a sport injury he had that wasn’t going away. He had been scrimmaging with his basketball team when he had felt a sharp pain behind his calf and had to sit down. Initially, he thought the injury was minor and would gradually go away with conservative treatment.

   A week later, limping and with no relief from the pain or swelling, he explained to me what had happened. I quickly advised him to schedule an appointment with his medical doctor due to the possibility of having a dangerous injury called “acute compartment syndrome” (or ACS) which can have long-term effects if it remains undiagnosed.

   Compartments are areas of the arms or legs that contain muscles, tendons, nerves and blood vessels wrapped together in a sheath of dense, fibrous connective tissue called fascia. The fascia gives support to the soft tissue and keeps the contained materials from displacing by not stretching very much.

   When swelling, bleeding or other products of inflammation occur inside a compartment, the increase in pressure on the capillaries, muscles and nerves can result in intense pain and loss of oxygenated blood to the muscle and nerve cells. ACS (such as the kind Los Angeles Dodgers’ second baseman Mark Ellis had last May) can result in necrosis “” tissue death so severe that the limb may need amputation if the swelling is not resolved quickly.

   Pain is felt within the affected compartment especially when stretched. Sometimes numbness, tingling or burning pain is felt. The areas will typically feel extremely tight and smooth to the touch. The disease condition is diagnosed by physical examination and usually a doctor will measure the pressure within the muscle or fascia to confirm.

   ACS is a severe medical emergency that requires a surgical technique called a fasciotomy. A doctor will make an incision to open the fascia tissue and relieve the swelling and pressure. Recovery time can take anywhere from several weeks to a couple months. While most sports-related injuries are not life threatening, ACS can result in amputations or even death. If you have an injury that is more painful than expected, is not healing quickly, or results in dysfunction, always seek medical advice as soon as possible.

Mikel Jackson is an athletic trainer for the staff of Sports Medicine For Young Athletes, a division of Children’s Hospital Oakland.