Muscle oxygenation in Type 1 diabetic and non-diabetic patients with and without chronic compartment syndrome.

Patrik Gustafsson,Sead Crnalic,David Edmundsson,Göran Toolanen,Albert G Crenshaw

doi:10.1371/journal.pone.0186790

Patrik Gustafsson, Sead Crnalic + Show 3 more

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https://doi.org/10.1371/journal.pone.0186790

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Journal: PloS one	Publication Date: Oct 23, 2017
Citations: 6	License type: CC BY 4.0

Affiliation: Umeå University, Gävle Hospital, University of Gävle

Abstract

BackgroundType 1 diabetic patients and non-diabetic patients were referred for evaluation for chronic exertional compartment syndrome (CECS) based on clinical examination and complaints of activity-related leg pain in the region of the tibialis anterior muscle. Previous studies using near-infrared spectroscopy (NIRS) showed greater deoxygenation during exercise for CECS patients versus healthy controls; however, this comparison has not been done for diabetic CECS patients.MethodsWe used NIRS to test for differences in oxygenation kinetics for Type 1 diabetic patients diagnosed with (CECS-diabetics, n = 9) versus diabetic patients without (CON-diabetics, n = 10) leg anterior chronic exertional compartment syndrome. Comparisons were also made between non-diabetic CECS patients (n = 11) and healthy controls (CON, n = 10). The experimental protocol consisted of thigh arterial cuff occlusion (AO, 1-minute duration), and treadmill running to reproduce symptoms. NIRS variables generated were resting StO2%, and oxygen recovery following AO. Also, during and following treadmill running the magnitude of deoxygenation and oxygen recovery, respectively, were determined.ResultsThere was no difference in resting StO2% between CECS-diabetics (78.2±12.6%) vs. CON-diabetics (69.1±20.8%), or between CECS (69.3±16.2) vs. CON (75.9±11.2%). However, oxygen recovery following AO was significantly slower for CECS (1.8±0.8%/sec) vs. CON (3.8±1.7%/sec) (P = 0.002); these data were not different between the diabetic groups. StO2% during exercise was lower (greater deoxygenation) for CECS-diabetics (6.3±8.6%) vs. CON-diabetics (40.4±22.0%), and for CECS (11.3±16.8%) vs. CON (34.1±21.2%) (P<0.05 for both). The rate of oxygen recovery post exercise was faster for CECS-diabetics (3.5±2.6%/sec) vs. CON-diabetics (1.4±0.8%/sec) (P = 0.04), and there was a tendency of difference for CECS (3.1±1.4%/sec) vs. CON (1.9±1.3%/sec) (P = 0.05).ConclusionThe greater deoxygenation during treadmill running for the CECS-diabetics group (vs. CON-diabetics) is in line with previous studies (and with the present study) that compared non-diabetic CECS patients with healthy controls. Our findings could suggest that NIRS may be useful as a diagnostic tool for assessing Type 1 diabetic patients suspected of CECS.

Highlights

Chronic exertional compartment syndrome (CECS) primarily occurs in subjects that may or may not be athletes [1] that engage in running and walking exercise
Oxygen recovery following arterial occlusion (AO) was significantly slower for chronic exertional compartment syndrome (CECS) (1.8±0.8%/sec) vs. CON (3.8±1.7%/sec) (P = 0.002); these data were not different between the diabetic groups
Our findings could suggest that near infrared spectroscopy (NIRS) may be useful as a diagnostic tool for assessing Type 1 diabetic patients suspected of CECS

Summary

Introduction

Chronic exertional compartment syndrome (CECS) primarily occurs in subjects that may or may not be athletes [1] that engage in running and walking exercise. The primary symptom is effort-related leg pain in an isolated muscle compartment that is recurrent, and the diagnosis is often verified by assessing intramuscular pressure (IMP) before and after exercise. In attempts to improve patient comfort and aid in diagnosis, clinicians and researchers have examined non-invasive techniques. Mohler et al [3] compared IMP measurements with near infrared spectroscopy (NIRS) in the anterior compartment of CECS patients versus healthy controls. Type 1 diabetic patients and non-diabetic patients were referred for evaluation for chronic exertional compartment syndrome (CECS) based on clinical examination and complaints of activity-related leg pain in the region of the tibialis anterior muscle. Previous studies using near-infrared spectroscopy (NIRS) showed greater deoxygenation during exercise for CECS patients versus healthy controls; this comparison has not been done for diabetic CECS patients.

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