INVESTIGATING LOWER LEG CHRONIC EXERTIONAL COMPARTMENT SYNDROME

Abstract

This study examined the hypotheses that ischaemia may be important in the aetiology of lower leg chronic exertional compartment syndrome (CECS) and that tension of tight fascia on the periosteal attachment may lead to linear uptake on bone scan. Participants with exercise-induced lower leg pain underwent compartment pressure testing (CPT), Thallium 201 SPECT imaging and triple phase isotope bone scan. Based on the results of the CPT, participants were divided into those with CECS (n = 25) and controls (n = 9). Qualitative and quantitative assessment of Thallium 201 SPECT images demonstrated no significant difference in muscle perfusion of the affected compartment between those patients with and without CECS. Using the qualitative results, Thallium was found to be a specific (100%) but not sensitive (9–7%) technique for the diagnosis of CECS. Patients with CECS did not have a characteristic appearance on bone scan with no difference in the proportion of those with and without linear uptake. The sensitivity of bone scans was 40% and the specificity was 56%. Bone scan appearance was unrelated to the duration of symptoms and the presence or absence of tibial tenderness. These results refute the belief that the pain of CECS is related to occlusion of the vascular supply to the affected area due to increased intracompartmental pressure. Given the poor sensitivity of Thallium and bone scan imaging, it is recommended at this stage that the diagnosis of CECS continues to be made using clinical findings in conjunction with CPT.