Even in the violent world of pro football, the injury suffered by Rahim Moore to his lower leg is a rare one … and it’s one that could cost him several weeks of this season — if not the whole season.
Moore developed what we doctors call a “compartment syndrome.” It’s hard to diagnose, and when missed, can lead to the loss of a limb.
You bet. It’s big time stuff. Even thinking about it gives a doctor the chills.
First, what’s a compartment? Think of each section of your arms and legs — front and back- upper and lower. Each section is called a compartment, and that compartment contains muscles, nerves, and blood vessels. It’s sort of like a room with lots of stuff in it.
Such as the top of your forearm. That’s a compartment. It’s covered by a thick, stiff tissue called fascia, which sort of holds everything down and together. We think of the forearm, top or bottom, as a tight compartment.
Now push against your quads or thigh — that’s also a compartment — and when you do, you can tell it has a little more give than say, a forearm. Which is good to have if you get smacked there. You’ve got room for swelling to develop.
Now go down and touch the front of your lower leg to the side of the shin. That’s a compartment, too. But it doesn’t have the give of a thigh. The bone is right there close to the skin. This is where Moore was hurt.
Actually, get smacked on either side of the shin bone, and there’s not a lot of room for swelling. It’s a tight space on both sides. And tight space can spell danger. (The front is called the anterior compartment, and the outside, the lateral compartment. The calf is “posterior”, but like the thigh has a lot of give.)
When that swelling builds up, it has no place to go, the lower leg feels like concrete, and the blood supply gets cut off to the muscles and nerves in the compartment. In the lower leg, they are the muscles that allow you to raise or twist your foot in and out.
Now, it takes a lot of trauma to develop a compartment syndrome. We usually see it with a car accident, a ski fracture of the shin, a fall down the stairs, or, in my experience, when a soldier is blown up. A football hit is low on the list of causes.
The key is making the diagnosis early, then surgery to restore the circulation before the muscle dies … it’s a race since that swelling can happen within just a few hours.
And that’s where it sounds like things got dicey. I’m sure Moore’s leg was killing him … but in this case, killing him more than a simple hit, and he was diagnosed quickly after calling the team trainers in the middle of the night. (One insider trick we doctors use is to gently stretch the toes or foot, and if it causes excruciating pain in a tight leg- that’s a red flag. We also use ultrasound to look at blood flow.)
The treatment is simple, yet tough. You literally make an incision down the course of the fascia to open the compartment up, relieve the pressure and get the blood flowing again.
The most common area for the symdrome is the lower leg, but I’ve seen it in the thigh, arm, and lower leg. Yet I think everyone’s trying to figure out what happened to cause this second quarter injury in Moore. There may have been some hits last week that made this week a setup for potential disaster.
Unusual injury with no room for delay.
And this morning’s out-of-the-blue emergency surgery is why Rahim Moore will most likely be able to step on the football field once again. The good news seems to be that the question is when –fortunately it doesn’t sound like an “if.”
He’s got some healing to do.