Abstract
BackgroundPatients with compartment syndromes have elevated intramuscular pressure (IMP) due to increased volume in the affected muscle. However, the accuracy of IMP as a parameter in diagnosing chronic compartment syndrome has been questioned. It has been observed that arterial pulsations create oscillations in the IMP in patients with abnormally elevated IMP. The amplitude of the IMP oscillations appears to be related to a pathogenic mechanism of elevated IMP. Therefore, the purpose of the present study was to investigate the relation between the amplitude of pulse-synchronous IMP oscillations and the absolute level of IMP with a high-end fiber-optic system in a human experimental model of abnormally elevated IMP (simulated compartment syndrome) of the leg. The hypothesis that the amplitude of the IMP oscillations is correlated to the absolute level of IMP was tested.MethodsIMP was measured at rest in the anterior tibial muscle in 12 legs of 7 healthy subjects (4 females and 3 males) with a mean age of 28 (range 23–38) years. The subject lay supine with his/her heel placed in a footrest. The foot was kept in a neutral position to avoid biased IMP readings. Measurements were performed at baseline and during 10 minutes with a model of abnormally elevated IMP (simulated compartment syndrome) applied. The abnormally elevated IMP was created by venous obstruction induced by a thigh tourniquet (65 mmHg) of a casted leg. Placement of the pressure-recording catheter was verified by sonography.ResultsThe IMP increased from 4.7 (SD = 1.8) mmHg at baseline to 48.6 (SD = 7.1) mmHg when the model of elevated IMP was applied. The amplitude of the pulse-synchronous oscillations was undetectable at baseline. It increased to 3.9 (SD = 1.4) mmHg with increasing IMP when the model was applied. The amplitude of the oscillations showed a positive correlation (r = 0.59) with the absolute level of IMP.ConclusionsThe amplitude of the pulse-synchronous IMP oscillations is correlated with the absolute level of IMP during abnormally elevated IMP. The oscillations of IMP may therefore be an additional parameter assuring the abnormally elevated IMP in the diagnosis of compartment syndromes.
Highlights
Patients with compartment syndromes have elevated intramuscular pressure (IMP) due to increased volume in the affected muscle
The amplitude of the IMP oscillations appears to be related to a pathogenic mechanism of elevated IMP and it varies with the arterial pulsations and the change in the compliance of the compartment (Styf 1995; Garabekyan et al 2009; Lynch et al 2009, Nilsson et al, 2014)
When the plaster cast was applied, the IMP increased to 15 mmHg and when the tourniquet was inflated to 65 mmHg, the IMP increased to over 40 mmHg within two minutes
Summary
Patients with compartment syndromes have elevated intramuscular pressure (IMP) due to increased volume in the affected muscle. The purpose of the present study was to investigate the relation between the amplitude of pulse-synchronous IMP oscillations and the absolute level of IMP with a high-end fiber-optic system in a human experimental model of abnormally elevated IMP (simulated compartment syndrome) of the leg. The amplitude of the IMP oscillations appears to be related to a pathogenic mechanism of elevated IMP and it varies with the arterial pulsations and the change in the compliance of the compartment (Styf 1995; Garabekyan et al 2009; Lynch et al 2009, Nilsson et al, 2014). The purpose of the present study was to investigate the amplitude of pulsesynchronous IMP oscillations relation to the absolute IMP with a high-end fiber-optic pressure measurement system in an experimental model of elevated IMP (simulated compartment syndrome) in the human leg. The hypothesis that the amplitude of the IMP oscillations is correlated to the absolute level of IMP was tested
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