Following the collision the athlete skated over to the bench and explained that he had sustained a knee to the thigh. Assessment revealed tenderness and spasm over his mid thigh which limited his range of motion. Symptoms were consistent with a quadriceps contusion and he was permitted to continue playing as tolerated. During the intermission, I performed soft tissue mobilization and passive stretching to maintain mobility in his leg. He finished the game without any further problems. Following the game the athlete was provided with treatment instructions for home and to follow up with me in the training room the next day.
The following day, the athlete contacted me noting that he was having a significant amount of pain which made weight bearing was very difficult. Hoping that there was a chance that he would be able to play in his game the next day, I advised him to keep weight off it and continue icing and working on his range of motion. I was surprised when I was contacted by his mother who noted that they had taken him to the ER for evaluation as his symptoms had gotten worse and he had began complaining of tingling in his foot. Xrays were negative but the tingling in his foot was a sign that the swelling in his thigh had increased to the point of limiting blood flow to the rest of his leg. This condition, also known as a compartment syndrome, required immediate surgery to alleviate the pressure on the blood vessels and nerves.
Following approximately a weeks stay in the hospital, the athlete returned home. He was non weight bearing for another 1-2 weeks after which he was permitted to progress to full weight bearing. Rehabilitation for this particular injury consisted of regaining full range of motion to the knee and restoring quad strength. He was permitted to begin a gradual return to skating after 4 weeks with clearance to return to game play at 6 weeks and was able to play in the remaining games that season.
Although a thigh compartment syndrome is uncommon it can go unrecognized resulting in complications that can hinder recovery. There were several things that were quite surprising to me about this injury. Until this episode I was only aware of compartment syndromes occurring in the shin area, the length of time needed for a full return to play was shorter than I had expected, and quick identification and treatment greatly enhance the prognosis for a full recovery.