Time to Get Our Act in Gear: Pediatric Compounding for Compartment Syndrome
Summer is almost here and that means many of us are going outside to get healthy and back to playing sports. It also means that while school sports are coming to an end, many teenage athletes are able to use their free time to train even harder to keep their bodies in shape. For fifteen-year-old Laurel, practice between the cross-country and track seasons started with the common pains of running but soon ballooned into swollen calves and knots so severe she had to drop out of exercise altogether. Healthcare specialists were baffled. As she detailed in her blog, they ultimately determined that she was suffering from compartment syndrome.
What Is Compartment Syndrome and How Does It Present?
Compartment syndrome (CS) is a serious condition that occurs when there is increased pressure within a closed fascial space, such as muscle. Since fascia do not expand, this increased pressure can rapidly lead to critical injury. The first symptom of CS is pain that is out of proportion to the inciting activity or injury. Initial symptoms include:
- Decreased sensation and trouble moving;
- Numbness and tingling;
- Severe pain that gets worse; and
- Swollen muscle(s).
These symptoms are common to many conditions and can be misdiagnosed. Left untreated, CS can cause permanent damage to muscle, blood vessels, and nerves.
What Pharmacists Need to Know for Pediatric Compounding
There are two types of CS, both of which are diagnosed through blood tests, interfacial pressure measurements, and imaging scans.
Acute CS typically occurs from blunt trauma, such as athletic injury to the legs, or perhaps a serious car accident. Acute CS is a surgical emergency and is treated with a fasciotomy, where an incision is made in the impacted fascia to relieve the pressure. Hyperbaric oxygen treatment may also be given so compromised tissues receive oxygen as quickly as possible. Post-surgical treatment for acute CS involves significant pain treatment.
Chronic CS is the more difficult type to diagnose because it results not from an identifiable trauma but occurs due to repeated exercise. Chronic CS usually presents in the leg, and is often misdiagnosed as shin splints or stress fractures. Early intervention is best, and can be facilitated by a knowledgeable pharmacist.
Managing chronic CS without surgery is possible and often preferred, especially in children. Initial treatment will, of course, involve rest and change of exercise. However, pain treatment and anti-inflammatory medications are also a big part of recuperation.
What Can Pharmacists Do?
Pharmacists are often more aware of patient’s lifestyle than their physicians are. If patients come in for exercise-related medication or braces and bandages, use the opportunity to ask questions about what sports your patients play and what injury and symptoms they are seeing. Custom pediatric compounding for topical pain creams may be more beneficial than systemic pain meds or over-the-counter treatments with components your patient is allergic to.
Another avenue of treatment includes counseling patients on the types of medications and conditions that are known to be risk factors for CS. Patients who are on anticoagulants or have hypotension or blood diseases that may increase intramuscular pressure should be aware of the risks of exercise and CS. You may have other seemingly unlikely patients who else could be at risk for CS, such as:
Adult and professional athletes may know to be on the lookout for CS but most others are not, especially teenagers used to wrapping their pain in braces and moving on. Luckily for Laurel, the teenager whose life continues to revolve around running, she had a medical team that was able to diagnose her early enough that one year post-surgery, she was active and running once again. She chronicled her experience in her blog so more people would be aware on what CS is and how to spot and treat it. Now it’s our turn to pass on the information.
At Pharmaceutica North America, we provide safe and effective compounding ingredients and up-to-date research on patient needs. Contact us today to see how we can help you serve your patients with first-class treatment.