Integrated Orthopedics’ Continuity of Care Between its Surgical and Physical Therapy Teams Provides Patient Cynthia Standley Relief and Healing from an Uncommon Leg Injury

Four days after completing the 5K Ice Cream Run in Glendale in May 2015, Cynthia Standley collapsed from excruciating leg pain on the floor in her kitchen while preparing dinner. “The leg pain came on so suddenly, without warning,” said Cynthia.

Cynthia went to the hospital, where an ultrasound was conducted. “The ultrasound did not show a blood clot, so I was sent home on crutches and pain medications with no clear diagnosis,” she said.

Cynthia knows a thing or two about the human body. She holds a Ph.D. in physiology and teaches it to first and second year medical students at the University of Arizona College of Medicine-Phoenix. She also directs the Neurological Sciences Block for first year medical students as well as the Art in Medicine program at UA COM-P. In her free time, she enjoys arts and crafts and hiking.

Cynthia’s next step in determining the cause of the severe leg pain, which continued after her initial collapse, was to see her family physician. Her doctor ordered an MRI, which was inconclusive.

“By July, I was still in so much pain,” Cynthia stated. “I felt like a rope was tied around my leg and squeezing it to death – there was so much pressure and the front of my leg was so swollen. I couldn’t walk without pain; it was constant and even woke me up at night.”

Having been a previous patient of Dr. Brian Gruber’s, she sought him out. Dr. Gruber initially thought it seemed like a type of compartment syndrome, which is not overly common. “He did his due diligence and testing, though,” said Cynthia. “He wanted to make sure it wasn’t anything related to my circulation or a more widespread neurological or muscular problem.”

Tests included an angiogram, an EMG, a nerve conduction study and a muscle ultrasound. During this time, Dr. Gruber had Cynthia take anti-inflammatory medication and put her on a nerve blocker to help manage the pain.

Cynthia’s cardiologist was also involved in her case and was certain it was not vascular. “After seven months and still so much pain, I pleaded with Dr. Gruber to do surgery,” Cynthia shared. “One thing about Dr. Gruber is that he will not do surgery unless he feels that it is in the best interest of his patient.”

She said that they discussed it and decided to move forward with a surgical intervention. The surgery involved peroneal nerve decompression and anterior/lateral fasciotomies in her left leg.

“Within two weeks after surgery I could already feel some relief in my leg,” said Cynthia. “The squeezing pressure was dissipating and the shock-like nerve pain was not as intense.” She went through three months of intense physical therapy post-surgery and did everything the therapists told her to do. “I was a good patient,” she shared. “I wanted to get better.”

Eventually, Cynthia was able to start walking regularly again. Over time, she successfully added perimeter hiking around the Phoenix Mountain Preserves to her routine. Cynthia’s big test came when her family took a trip to Zion National Park and she was able to hike to the top of Hidden Canyon – an elevation change of 1,000 feet – with no pain at all. “I was beyond thankful,” she said.

Cynthia said one of the best things about Integrated Orthopedics is the continuity of care. “It is really outstanding to have the care between your physician and the physical therapy team so integrated as you move toward recovery,” she said.

In addition to feeling well-cared for by the entire Integrated Orthopedics’ team, Cynthia said, “Dr. Gruber is very knowledgeable, humble, compassionate, down-to-earth and dedicated to his patients, with their best interest always in mind.”

While Dr. Gruber told Cynthia she should be able to return to running and 5K races again, she now prefers hiking. Her next goal? To backpack to the bottom of the Grand Canyon this coming September.

What is Traumatic Compartment Syndrome

Compartment syndrome is increased pressure within one of the body’s compartments that contain muscles and nerves. Compartment syndrome most commonly occurs in the compartments of the legs or arms.

Compartment syndrome can be acute or chronic. In Cynthia’s case, she experienced chronic compartment syndrome. This condition is often exercise-induced, where the pressure in the muscle compartment increases to extreme levels during exercise.  This can initially result in increased pain. The symptoms can continue with numbness and tingling in the affected extremity. Chronic compartment syndrome is most common in athletes who participate in repetitive impact sports such as running.

Chronic compartment syndrome in the lower leg can be treated conservatively or surgically. Conservative treatment could be modifications to activity and exercise. Surgery is often the most effective treatment for compartment syndrome. During surgery, incisions are made in the affected muscle compartments to allow them to decompress. The decompression relieves the pressure and allows for increased blood flow throughout the muscle.

Acute compartment syndrome is most often a medical emergency. Chronic compartment syndrome can develop into the acute syndrome and permanent muscle and newer damage can occur. Both acute and chronic compartment syndrome require immediate medical attention.