Specialised Chronic Compartment Measurement Clinic in a District General Hospital: Is it Worthwhile?

Abstract

Chronic compartment syndrome is one of the conditions that cause exertional pain in the young. In this condition, a careful history taking is usually the key for making the correct diagnosis, but intracompartmental pressure measurement that has high sensitivity and specificity rates can add invaluable confirmation, especially when surgical decompression is indicated. In a district general hospital there is usually a logistical problem in performing compartmental pressure measurement. In this study, we describe our experience in dealing with such a problem by setting up a quarterly specialised clinic for intracompartmental pressure measurement that, according to our knowledge, is unique in the UK. We retrospectively reviewed the medical records of 42 patients referred to our specialised clinic and documented the referral patterns, clinical picture, additional investigations, pressure measurement results, final diagnosis and outcome of treatment. The intracompartmental measurement was recorded pre- and post-exercise on the treadmill for 1 min or 5 min and results were interpreted according to published criteria. The mean age of the referred 42 patients was 33.1 years (range, 15-78 years). There were 16 positive results (38%) confirming the diagnosis of chronic compartment syndrome and four clinically characteristic cases of this condition with negative results. There were 22 negative results (53%), one borderline, and three patients were not tested for different reasons. All of the 10 patients who were treated surgically had positive pre-operative test results. An inappropriate referral rate of approximately 52% was encountered that had a significant impact on the waiting time for the proposed test (5.7 months), which is far longer than the 18-week target for treatment in the NHS. We found that a positive test is a strong predictor of a successful outcome of surgical treatment. Such a specialised clinic, therefore, should only receive carefully assessed patients.