An unfit man with painful leg swelling after exertion

Case scenario

Colin, a 44-year-old normally healthy but unfit man, presented in the surgery two days after participating in a day-long boot camp as a bonding exercise with his workmates. He said he had done more squats than all his workmates, and won the prize for enthusiasm. Over the day or so after the camp he had developed worsening leg cramps that affected his sleep, and by 48 hours he was hobbling due to the pain. He was prescribed anti-inflammatories for five days and advised to work from home. Two days later (four days after the camp), he has returned for review because he has noticed increasing tense swelling in his calves and thighs and that the pain is worsening. On questioning he has dark urine, which he thinks is due to dehydration.

• What features would you expect to find on clinical examination in this patient?

• What investigations, if any, are indicated for diagnosis of compartment syndrome?

• What are the indications for incision for decompression of compartment syndrome?

• How should Colin’s urinary signs be investigated and managed?

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