YOUR PAPER CUT IS NOTHING OFFICE WARRIOR

by Orson on Sep 23, 2009 1:05 PM EDT

Stoics sound great when you quote them. Take Seneca, for instance:

Scorn pain: either it will go away or you will

Cool, right? Works really well when you twist your ankle in a minor fashion on a run, or when you pull a shoulder muscle reaching for a bottle of scotch in the back of the liquor cabinet.

Hi, I'm Seneca. Full of bullshit advice.

Rarely do you have to face an injury that might actually give you option two here, but thanks to compartment syndrome, it is something football players can face on the field. Case in point: Washington State running back James Montgomery, who could have lost his leg or even died if he hadn't gotten a speedy operation to relieve pressure in his leg caused by compartment syndrome.

Close friend Dwight Tardy, a senior running back, said team doctor Ed Tingstad told him Montgomery "probably could have died" if a Sunday morning operation had been delayed too long. A wait of one to two hours might have led to amputation, Tardy said Tingstad told him.

"He (Tingstad) was pretty rattled and shook up," Tardy said. "He started crying."

(HT: CFT.) Compartment syndrome is fairly rare, and can be caused by a wide array of possible factors. It also has varying degrees of badness, thus ranging from Jason Taylor's relatively minor case to Montgomery's extremely serious one where it will take 6-12 months to figure out if he'll even play again.

If you're morbidly curious and have a strong stomach, it looks like this. Scorn pain all you like, but respect it when it's talking to you, since it might save your leg (or your life.)

(Also, don't listen to Seneca, a notorious suckup to Nero. That Nero.)

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VT had two guys suffer that in the same year: Eddie Royal and a highly rated offensive lineman named Tripp Carroll. Eddie (being Eddie, meaning he’s Superman) was up and around in a couple of months. Tripp Carroll’s ended his football playing days. He never came back.

by Cotton Hill's Shins on Sep 23, 2009 1:15 PM EDT reply actions

Maybe teh nastiest thing I’ve seen on this site – which is saying a lot !

by BamaCPA on Sep 23, 2009 1:22 PM EDT reply actions

“For there was never yet philosopher who could endure the toothache patiently.” (Bill E. Shakes)

by Sherlock Hemlock on Sep 23, 2009 1:25 PM EDT reply actions

I like to refer to compartment syndrome as pre-zombie rot.

by hlh on Sep 23, 2009 1:27 PM EDT reply actions

hey orson,
there’s more to this story than you might think. to diagnose compartment syndrome you can either rush to the OR based on story and clinical presentation, OR you may use this device to get ‘compartment pressures’…

http://www.drmichaelcohen.com/comp/Compartment1.jpg

i believe the mighty seneca might have laughed at this thing but i can tell you, from having been on the delivering end of a stryker needle that it could be used successfully at GITMO.

best.

by 911doc on Sep 23, 2009 2:14 PM EDT reply actions

A better quote from a philosopher of the more hedonistic persuasion:

“I want to share something with you: The three little sentences that will get you through life. Number 1: Cover for me. Number 2: Oh, good idea, Boss! Number 3: It was like that when I got here.”

by Terry Bowdens Shoe Lifts on Sep 23, 2009 2:16 PM EDT reply actions

and OBTW, that picture is of a ‘fasciotomy’ which allows the blood building up deep in the leg to exit without killing the leg. they do not heal nicely and this dude’s career as a leg model is over.
cheers.

by 911doc on Sep 23, 2009 2:16 PM EDT reply actions

The same thing happened to Damien Gary circa 2003, if memory serves. If they catch it in time, you can make a quick and complete recovery. If they don’t, you can lose a leg. Scary, scary stuff. Glad this story had a happy ending.

by T. Kyle King on Sep 23, 2009 2:57 PM EDT reply actions

James Montgomery is proof that actual good things can escape the black hole of suck known as Rancho Cordova, I wish him a speedy recovery.

by AERose on Sep 23, 2009 3:03 PM EDT reply actions

Get well, James Montgomery. If foobaw doesn’t work out, you could always be the lead plaintiff in the creatine class action.

by haveagreatday on Sep 23, 2009 3:28 PM EDT reply actions

Being a distance runner who only watches football, I’ve only heard of anterior compartment syndrome in distance runners. It’s usually due to overtraining, increasing mileage too quickly or switching from a more forgiving to less forgiving surface. In running it’s usually an overuse injury that’s extremely painful. The pain is usually what causes runners to stop before severe damage is done. In football is this due to overuse or trauma?

by Brad on Sep 23, 2009 9:47 PM EDT reply actions

brad,
the vast majority of compartment syndrome caes are in orthopedic ‘crush’ injuries… anvil falling on outstretched leg… run over by car… in football i would opine that most compartment syndrome injuries are traumatic… helmet to leg without fracture etc… however, i believe it would be possible to develop an anterior compartment syndrome from overuse, of even a rupture of a deep arterial vessel due to forcible flexion of the foot against resistance.

the way to think of it is to realize that all the muscle compartments of the leg are contained within separate fascial layers, and the healthy fascia looks like saran wrap but is much stronger. so, if you have a bleed of an arterial (high pressure) vessel within one of these ‘compartments’ then it can bleed ENOUGH to prohibit, within that comapartment, blood flow beyond the area of injury. so, it is a lot like an internal tourniquet in some ways.

you have a few hours to make this diagnosis and from an MD perspective the real trick is putting the ‘compartment syndrome’ on your list of possibilities when evaluating such a patient.

best.

by 911doc on Sep 24, 2009 10:45 AM EDT reply actions