Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome

Eric Williams,A Dellon,Gregory Guyton,Don Detmer

doi:10.1186/1749-7221-4-4

Abstract

BackgroundChronic exertional compartment syndrome (CECS) is characterized by elevated pressures within a closed space of an extremity muscular compartment, causing pain and/or disability by impairing the neuromuscular function of the involved compartment. The diagnosis of CECS is primarily made on careful history and physical exam. The gold standard test to confirm the diagnosis of CECS is invasive intra-compartmental pressure measurements. Sensory nerve function is often diminished during symptomatic periods of CECS. Sensory nerve function can be documented with the use of non-painful, non-invasive neurosensory testing.MethodsNon-painful neurosensory testing of the myelinated large sensory nerve fibers of the lower extremity were obtained with the Pressure Specified Sensory Device™ in a 25 year old male with history and invasive compartment pressures consistent with CECS both before and after running on a tread mill. After the patient's first operation to release the deep distal posterior compartment, the patient failed to improve. Repeat sensory testing revealed continued change in his function with exercise. He was returned to the operating room where a repeat procedure revealed that the deep posterior compartment was not completely released due to an unusual anatomic variant, and therefore complete release was accomplished.ResultsThe patient's symptoms numbness in the plantar foot and pain in the distal calf improved after this procedure and his repeat sensory testing performed before and after running on the treadmill documented this improvement.ConclusionThis case report illustrates the principal that non-invasive neurosensory testing can detect reversible changes in sensory nerve function after a provocative test and may be a helpful non-invasive technique to managing difficult cases of persistent lower extremity symptoms after failed decompressive fasciotomies for CECS. It can easily be performed before and after exercise and be repeated at multiple intervals without patient dissatisfaction. It is especially helpful when other traditional testing has failed.

Highlights

Chronic exertional compartment syndrome (CECS) is defined as a condition in which exercise or heavy exertion creates elevated pressures within the closed space of an extremity muscular compartment which subsequently causes consistently recurring symptoms and/or disability by progressive impairment of the neuromuscular function of the involved compartment [1,2,3,4,5,6]
We present a case where non-invasive, non-painful neurosensory testing successfully diagnosed the problem of exertional compartment syndrome and was used to help guide and document successful management of the disorder in a patient with suspected deep distal posterior compartment syndrome
If one could accurately determine the real-time function of the peripheral nerve the compartment one could begin to refine the clinical treatment of patients with suspected CECS

Summary

Introduction

Chronic exertional compartment syndrome (CECS) is defined as a condition in which exercise or heavy exertion creates elevated pressures within the closed space of an extremity muscular compartment which subsequently causes consistently recurring symptoms and/or disability by progressive impairment of the neuromuscular function of the involved compartment [1,2,3,4,5,6]. Symptoms may consist of an aching pain, squeezing sensation, sharp pains, or possible paresthesias in the feet It is not uncommon for bilateral mirror image compartments to be involved. Chronic exertional compartment syndrome (CECS) is characterized by elevated pressures within a closed space of an extremity muscular compartment, causing pain and/or disability by impairing the neuromuscular function of the involved compartment. Sensory nerve function can be documented with the use of non-painful, non-invasive neurosensory testing

Methods

Discussion

Conclusion