Abstract
PurposeTo investigate distributions and identify possible differences in intramuscular pressure (IMP) values at 1 min post-exercise between the four muscle compartments of the lower leg, in patients with exertional leg pain with or without chronic exertional compartment syndrome (CECS).MethodsA consecutive series of patients seeking orthopaedic consultation for exertional leg pain underwent IMP measurements between 2009 and 2018. The diagnosis of CECS was confirmed (n = 442) or ruled out (n = 422), based on the patient’s history, clinical examination, and IMP measurements.ResultsThe median (range) 1 min post-exercise IMP values in affected compartments in the patients diagnosed with CECS were 33 (25–53) mmHg (deep posterior), 35 (27–54) mmHg (superficial posterior), 40 (26–106) mmHg (lateral), and 47 (24–120) mmHg (anterior). In patients with no CECS, the median (range) 1 min post-exercise IMP values in the compartments were 12 (2–28) mmHg (deep posterior), 12 (2–27) mmHg (superficial posterior), 14 (2–26) mmHg (lateral), and 18 (4–34) mmHg (anterior). The IMP was significantly lower in the lateral and both posterior compartments than in the anterior compartment in both patients diagnosed with CECS and patients without CECS.ConclusionThe study demonstrates significantly lower IMP values in the posterior and lateral compartments compared to the anterior compartments. These findings suggest a lowering of the IMP 1 min post-exercise cut-off value for diagnosing CECS in the lateral and both posterior compartments, which may lead to improved treatment of patients with suspected CECS in the lower leg.Level of evidenceLevel II.
Highlights
Chronic exertional compartment syndrome (CECS) causes exercise-induced lower leg pain, which is most commonly experienced by sportsmen and women [8]
The median intramuscular pressure (IMP) values in patients with no chronic exertional compartment syndrome (CECS) showed a similar variation in distribution regarding the four compartments to that seen in the CECS patients, with the highest IMP values in the anterior compartment
These findings suggest an adjustment of the IMP 1 min post-exercise cut-off value for diagnosing CECS in both of the posterior compartments and the lateral compartment
Summary
Chronic exertional compartment syndrome (CECS) causes exercise-induced lower leg pain, which is most commonly experienced by sportsmen and women [8]. Most patients with CECS have a high level of physical activity, with running being the most common individual sport activity and soccer being the most common team activity [4]. The diagnosis may be missed by clinicians since these patients are asymptomatic at rest and show minimal findings at physical examination [10]. Among a range of distinct entities causing exercise-induced leg pain CECS is one of the most common [19]. In a retrospective review of 150 athletes with exercise-induced leg pain, the prevalence of CECS in the lower legs was reported to be 33% [3]. Bilateral symptoms are common, and occur in 67–95% of the patients [12, 22, 24]
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