Cause Of Leg Pain Research Articles

Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome is a well-described potential cause of leg pain in high-level athletes and soldiers. Surgical treatment of chronic exertional compartment syndrome usually involves fasciotomy, with a reported rate of complications of up to 16%, including failure of complete compartmental release and delayed return to normal daily activity, which can take up to 6 to 12 weeks. The use of a minimally invasive approach under ultrasound guidance seems to improve clinical outcomes in young active patients. We recommend the following steps for effective execution of ultrasound-guided percutaneous fasciotomy: (1) location of the compartmental fascia and identification of the superficial peroneal nerve, (2) skin incision, (3) insertion of a hook under the compartmental fascia, and (4) sectioning of the fascia.

Aetiologies of Leg Pain among Patients Presenting to a Vascular Surgery Clinic.

To determine the frequency and pattern of different aetiologies of leg pain among patients visiting vascular surgery clinics. Cross-sectional study. Place and Duration of the Study: Vascular Surgery Clinics of the Aga Khan University Hospital, Karachi, Pakistan, between February 2021 and June 2023. This study examined patients presenting with leg pain for the first time at vascular surgery clinics. The socio-demographic and clinical data including the clinical symptoms, physical examination findings, and management of leg pain were noted using a specially designed proforma. In a total of 142 patients (200 limbs), 82 (57.7%) were females and 60 (42.3%) were males, with a mean age of 46.8 ± 15.1 years. The patients' mean body mass index (BMI) was 30.2 ± 7.9 kg/m2. Ninety-one (64.1%) patients had a predominantly standing job compared to 51 (35.9%) patients who had a predominantly sitting job. The most common aetiology of leg pain was chronic venous insufficiency (CVI), diagnosed in 107 (53.5%) patients, followed by neurogenic pain [41 (20.5%)], musculoskeletal pain including knee osteoarthritis [30 (15.0%)], and arterial insufficiency [22 (11.0%)]. Conclusion: CVI followed by neuropathic pain was the leading cause of leg pain in vascular surgery clinics at a tertiary care hospital. Chronic venous insufficiency, Arterial insufficiency, Vascular surgery, Leg pain, Musculoskeletal pain, Neuralgia.

Early-stage chronic venous disorder as a cause of leg pain overlooked for lumbar spinal disease

Leg pain can be caused by both lumbar spinal disease and chronic venous disorder (CVD) of leg veins, but their clinical differences have not been thoroughly investigated. This study aimed to determine the incidence of CVD among patients visiting a spine center for leg pain. A total of 196 cases underwent ultrasound examination with a diagnosis rate were 85.7% (168 cases). CVD-diagnosed cases were divided into two groups based on the severity of lumbar spinal disease. The Clinical grades, symptom areas, and symptom types were compared. The differences in symptom improvements with vasoactive medication were also assessed. The most common symptom area was calf then the foot in CVD, while calf then thigh in lumbar spinal disease. Tingling-paresthesia was the most common symptom type for both, with pain and cramping similarly common in CVD and pain more common than cramping in lumbar spinal disease. Considering that the majority of CVD cases (78.6%) had minor cutaneous changes and almost half of cases (41.7%) had refluxes only in tributaries, significant differences in symptom improvement in CVD-dominant group suggested that early-stage venous reflux is a symptomatic disease and a possible cause of leg pain and other symptoms.

A Traumatic Neuroma Formation Following Fasciotomy for the Treatment of Tibialis Anterior Muscle Herniation: A Case Report

Muscle herniation of the lower extremity, such as tibialis anterior muscle herniation (TAMH), is not a rare cause of leg pain in athletes. However, a few studies have reported surgical treatment for TAMH, and the optimal surgical procedure remains controversial. Fasciotomy was reported to be effective for patients with TAMH. However, this procedure would be associated with a risk of intraoperative injury to the superficial peroneal nerve (SPN), although no previous literature has reported this complication. This case report aimed to report a case of bilateral TAMHs in which a traumatic neuroma of the SPN developed after fasciotomy. A 16-year-old baseball player presented with painful swelling lesions of the bilateral lower extremities (1 lesion on the right, 3 lesions on the left) after sports activities. An ultrasonographic evaluation showed swelling lesions of the anterolateral parts of the bilateral lower extremities in the standing position after dashing, while these lesions were not detected in the supine position. A fasciotomy of the crural fascia was performed after conservative treatment failed. Several days after surgery, the patient presented with weakened touch sensation over the dorsal area of the left foot. At the three-month follow-up examination, a swelling lesion with hard elasticity was identified. The palpation of this lesion caused a radiating sensation in the area supplied by the SPN. He was able to return to playing baseball six months after surgery. The patient was asymptomatic without palpation of the traumatic neuroma of the SPN at the latest follow-up examination. In conclusion, the present case report suggests that orthopedic surgeons need to consider the risk of iatrogenic injury to the SPN during fasciotomy for the treatment of TAMHs. However, there may be a risk of injuring the SPN because of the many variants of the course of the SPN within the compartment of the lower extremities.

Popliteal Artery Entrapment Syndrome: A Diagnostic and Treatment Enigma for Orthopaedic Surgeons.

Popliteal artery entrapment syndrome (PAES) is an uncommon condition that causes recurrent posterior leg pain and foot paresthesia in running athletes. This condition occurs most commonly due to an accessory or abnormal implant of the medial head of the gastrocnemius muscle. It may mimic or coincide with other chronic conditions of the lower extremity including chronic exertional compartment syndrome but is most consistent with vascular claudication. Clinical features that distinguish PAES from other causes of leg pain include a sensation of coolness of the posterior leg during exercise and associated paresthesia of the plantar aspect of the foot. Physical examination often reveals decreased intensity of the posterior tibial or dorsalis pedis pulses with passive dorsiflexion or active plantarflexion of the ankle. Diagnostic tests that confirm the presence of PAES include lower extremity angiography during active resisted plantarflexion or maximal passive dorsiflexion, and magnetic resonance angiography done after exercise provocation. Nonsurgical treatment with physical therapy and stretching of the gastrocnemius complex should be done as the first line of treatment. When conservative treatments are ineffective, referral to a vascular specialist for surgical intervention with a muscular band excision or transection, vascular bypass, or arterial reconstruction is necessary.

Tibialis anterior muscle hernia: A rare cause of leg pain. Case report and review of the literature

Abstract Introduction Muscular hernias in the lower limb are a rare entity that have seldom been described in the literature, from 1929 about 200 cases of muscle hernias have been described. Case Here, we present a case of tibialis anterior muscle hernia and discuss the aetiology behind the same. Furthermore, we attempt to amalgamate existing knowledge to provide some guidance for investigation and management of this important diagnostic consideration. Conclusion Lower limb hernias are rare but should be considered as a differential for unidentified lower limb swellings. There is no clear consensus in literature about treatment, so every case must be individualized.

Post-exercise leg compartment pressure measurements in asymptomatic collegiate distance runners: a prospective study

Background: Chronic exertional compartment syndrome (CECS) is an uncommon cause of leg pain in running athletes. Post-exercise compartment pressure measurements are an invasive test that many clinicians use for making the diagnosis of CECS. We sought to determine if intracompartmental pressures in anterior leg compartments of asymptomatic collegiate distance runners meet established criteria for diagnosis of exertional compartment syndrome. Methods: Thirty collegiate running athletes underwent 1-minute post-exercise compartment pressure measurements of bilateral anterior leg compartments. Each was asked to run for 15 min at a moderately intense pace, and then underwent measurements performed at 1-minute postexertion with a needle manometer. Fifteen male and 15 female collegiate running athletes from age 18 to 23 yr (average 20.8 yr) underwent post-exercise compartment pressure testing of the legs. Results: Eleven (six men, five women) demonstrated 1-minute post-exercise compartment pressure measurements that met criteria for diagnosis of exertional compartment syndrome in at least one leg based on established criteria (>30 mmHg). Of these 11, four demonstrated positive measurements bilaterally (two men, two women). Intracompartmental pressure measurements ranged from 16 mmHg to 88 mmHg (average 27.5 mmHg). Measurements of anterior leg compartments performed at 1-minute post-exercise were indicative of exertional compartment syndrome in more than one-third of the asymptomatic running athletes tested (11/30, 36.7%). Conclusions: Elevated anterior leg compartment pressures were prevalent in collegiate distance runners despite a lack of symptoms. Post-exercise compartment pressure measurements should be viewed only as an indicator of exertional compartment syndrome and not relied upon as a confirmatory test. Level of Evidence: Level IV.

Evaluation of patients presenting with leg pain to the pediatric rheumatology polyclinic: A single center experience

Objective: Leg pain is a common complaint in childhood and is one of the most common causes of admission to pediatric rheumatology outpatient clinics. The aim of this study was to analyze the demographic data and etiology of patients presenting with leg pain and to reveal common causes. Material and Methods: The files of patients who presented to our pediatric rheumatology outpatient department between August 2018 and August 2019 due to leg pain were retrospectively reviewed. Patient demographic, clinical, and laboratory data were obtained from the patients’ files and hospital database. An information form that collected data on patient gender and current age, age at disease onset, age at diagnosis was completed for all patients. Results: The study included 270 patients with a mean age of 10.4 ± 4.8 years, including 170 (63%) females and 100 (37%) males. The mean age of onset of complaints was 9.1 ± 3.2 years. The most common cause of leg pain was hypermobility syndrome with 74 (27.4%) patients. Respectively, 41 (15%) patients were diagnosed with growing pain, 39 (14,4%) patients with Osgood-Schlatter disease, 32 (11,8%) patients with post-infectious arthritis / arthralgia, 28 (10,3%) patients with fibromyalgia, 20 (7,4%) patients with juvenile idiopathic arthritis. Two patients had acute lymphoblastic leukemia and 10 patients had acute rheumatic fever. All patients with fibromyalgia were girls and adolescents. 62.5% of leg pain was bilateral. 44% of patients really had leg pain. Although the complaint of presentation in other patients was leg pain, it was not the legs but the localized knee and ankles. Conclusion: Leg pain is a common complaint both in childhood and adolescence. Hypermobility syndrome was the most common cause in both periods. Osgood-Schlatter disease and fibromyalgia should be considered especially in adolescence and growing pain in childhood. In addition to these benign diseases, diseases such as juvenile idiopathic arthritis and acute rheumatic fever should be considered, especially when the joint is swollen. Leukemia’s, avascular necrosis and meniscopathies may also present with leg pain. As a result, leg pain in children is a complaint that should be considered and patients should be questioned well and differential diagnosis should be made well.

FUNCTIONAL POPLITEAL ARTERY ENTRAPMENT SYNDROME: INVESTIGATION WITH DYNAMIC AND DOPPLER ULTRASOUND

A. Background Functional popliteal artery entrapment syndrome (fPAES), a cause of exertional leg pain, has a clinical presentation and clinical findings that are often indistinguishable from those of other leg pain causes (1). This condition may also coexist and overlap in symptomatology with other leg pain causes, further complicating the diagnosis (2). Although fPAES is usually considered a rare cause of leg pain (3), the true incidence of this condition is unknown, and fPAES is likely underdiagnosed and underreported (4). A missed diagnosis may result in disease progression and the use of unnecessary invasive procedures (3), and untreated fPAES may lead to popliteal artery damage, embolization, and limb ischemia (5). Although a diagnostic method using a combination of dynamic ultrasound and MR imaging/MR angiography has been described for fPAES (5), to our knowledge, no investigational studies have been performed to assess the dynamic ultrasound findings in this entity. This study sought to evaluate the usefulness of dynamic plantar flexion and dorsiflexion of the calf and the effect on the popliteal artery Doppler waveform in patients with clinically suspected fPAES and no structural abnormality. B. Methods We performed a retrospective review of ultrasound studies in patients who presented with clinically suspected PAES over a 3-year period. The ultrasound studies consisted of an anatomic survey of the popliteal. Dynamic nonresistant dorsiflexion and plantar flexion evaluations of the popliteal artery plus spectral Doppler evaluations of the popliteal artery obtained in neutral, plantar flexion, and dorsiflexion positions were performed before and after patients exercised. Patients with anatomic abnormalities were excluded. The following parameters were assessed: The proportion of symptomatic knees versus asymptomatic knees in which plantar flexion and/or dorsiflexion of the foot resulted in popliteal artery compression. The peak systolic velocity (PSV) of the popliteal artery in all positions for knees with and knees without dynamic popliteal artery compression. The absolute value change in PSV of the popliteal artery from neutral to plantar flexion and from neutral to dorsiflexion in the pre- and postexercise state for knees with and knees without dynamic popliteal artery compression. ROC analysis for clustered data was used to assess the ability of PSV to distinguish between knees with and knees without arterial compression. C. Results A total of 88 knees (77 symptomatic, 11 asymptomatic) in 45 patients were included in the study. Dynamic arterial compression was observed in 38% (29/77) of symptomatic knees. No compression seen in asymptomatic knees. Both pre-exercise and postexercise knees with arterial compression had significantly higher absolute changes in PSV from neutral to plantar flexion versus knees without arterial compression (Table). There was a smaller significant change in PSV from neutral to dorsiflexion in the pre-exercise state. There was no significant change in PSV in the postexercise state from neutral to dorsiflexion or with respect to PSV values at any position between knees with and knees without arterial compression. D. Conclusions/Significance In patients with clinically suspected PAES without anatomic abnormality, dynamic ultrasound demonstrated compression of the popliteal artery in 38% of knees. No dynamic arterial compression was seen in asymptomatic knees. There was a significant elevation in PSV from neutral to plantar flexion in pre- and postexercise states and from pre-exercise neutral to dorsiflexion positions in knees with arterial compression versus knees without arterial compression. Tables [Table: see text] References Joy SM, Raudales R. Popliteal artery entrapment syndrome. Curr Sports Med Rep. 2015;14(5):364-367. Hislop M, Kennedy D, Cramp B, Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. J Sports Med (Hindawi Publ Corp). 2014;2014:105953. Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic exertional compartment syndrome? Case Rep Med. 2017;2017:6981047 Hislop M, Brideaux A, Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017;46(9):1241-1248. Williams C, Kennedy D, Bastian-Jordan M, Hislop M, Cramp B, Dhupelia S. A new diagnostic approach to popliteal artery entrapment syndrome. J Med Radiat Sci. 2015;62(3):226-229.

Therapeutic potential of hyaluronic acid/chitosan nanoparticles for the delivery of curcuminoid in knee osteoarthritis and an in�vitro evaluation in chondrocytes

Knee osteoarthritis (OA) is the main cause of leg pain in middle-aged and elderly individuals. Hyaluronic acid (HA), as well as curcuminoid, has been used in the treatment of knee OA. In the present study, HA/chitosan nanoparticles (CNPs) were prepared for the delivery of curcuminoid, in order to investigate whether HA and curcuminoid can act synergistically as a better treatment option. The knee OA model was established by the Hulth method, and a knee OA chondrocyte model was constructed by the co-induction of interleukin-1β and tumor necrosis factor (TNF)-α. The drug loading capacity of HA/CNP for the delivery of curcuminoid was measured by an ultraviolet assay, and the cytotoxicity to chondrocytes was measured by an MTT assay. Collagen II was detected by immunofluorescence, and the expression levels of nuclear factor (NF)-κB and inflammation-related genes in cartilage tissue and chondrocytes were detected. Chondrocyte proliferation was determined by an EdU assay, and chondrocyte apoptosis was determined by flow cytometry. The Mankin pathological score of the Outerbridge classification was obtained. The results demonstrated that the optimum drug loading capacity of HA/CNP for the delivery of curcuminoid was 38.44%, with a good sustained release function. HA/CNP treatment resulted in inhibition of the NF-κB pathway, as well as the expression of matrix metalloproteinase (MMP)-1 and MMP-13, but it increased collagen II expression. HA/CNP for the delivery of curcuminoid significantly decreased the Outerbridge classification and Mankin pathological scores to close to normal until the 4th week. Furthermore, it was also observed that all the effects of HA/CNP on the delivery of curcuminoid were more prominent compared with the effects of HA or curcuminoid treatment individually. Taken together, these findings demonstrated that HA/CNP for the delivery of curcuminoid may suppress inflammation and chondrocyte apoptosis in knee OA via repression of the NF-κB pathway.

Botulinum toxin: A new treatment for functional popliteal artery entrapment syndrome? Five patients relieved more than one year

Functional popliteal artery entrapment syndrome (FPAES) is an uncommon cause of exercise-induced leg pain. Artery compression is mostly due to hypertrophic gastrocnemius muscles (GCM) without any anatomic abnormality. Surgical arteriolysis of popliteal artery is often proposed, sometimes with myotomy. But long-term efficacy of surgery is unknown. As botulinum toxin A (BoNT-A) injections can induce localised and partial muscular atrophy and hypotonia, we supposed that BoNT-A injections in GCM could relieve pain associated with FPAES. We describe five patients with a FPAES treated with BoNT-A and followed more than one year. Diagnostic was confirmed by provocative tests in plantar or dorsal flexion of the ankle on vascular imagery (doppler ultrasonography, computed tomography or magnetic resonance angiography). Other causes of leg pain were excluded, such as chronic exertional compartment syndrome with compartment pressure after exercise. BoNT-A was injected under electromyograph guidance in the proximal third of both heads of GCM (two sites/head), with 25 to 37.5 U of Incobotulinum toxin A or 100 to 160 US of Abobotulinum toxin A. Exercise-induced leg pain completely disappeared after treatement for all patients and they resumed their normal level of sports or physical professional activities. One patient was treated twice, eight months after the first injections, since he relapsed. There were no muscular weakness but the patient treated with the highest dose had transient asthenia and mictional disorders. Four patients are currently still asymptomatic, with a follow up between 14 and 28 months. One patient relapsed late after 50 months. BoNT-A injections could be used as a new conservative therapeutic strategy in FPAES and could reduce functional compression by improving artery-GCM impingement. This study is the first to demonstrate that BoNT-A could induce long-lasting resolution of symptoms, more than one year as previoulsy described (Hislop, 2017). It is well tolerated if the dose is well choosed.

Could botulinum toxin be a treatment for functional popliteal artery entrapment syndrome? A preliminary study

Functional popliteal artery entrapment syndrome (FPAES) is an uncommon cause of exercise-induced leg pain. Contrary to the anatomic type, there is no anatomical abnormality: entrapment is caused by hypertrophic gastrocnemius muscles (GCM). Even though arterial compression is purely functional, a surgical arteriolysis of popliteal artery is often proposed, in order to release the artery from adjacent structures. It is sometimes associated with myotomy. Studies on surgical treatment lack for cases. We hypothesize that botulinum toxin A (BoNT-A) injections in GCM could improve GCM-artery impingement by inducing localized and partial muscular atrophy and hypotonia. This retrospective study included patients with FPAES treated with BoNT-A. Clinical exam, ankle brachial pressure index after exercise, provocative tests in plantar or dorsal flexion of the ankle (Doppler ultrasonography, computed tomography or magnetic resonance angiography) were used for diagnostic. Other causes of leg pain were systematically excluded with further investigations, such as compartment pressure after exercise, low back and leg imagery. BoNT-A was injected in the proximal third of both heads of GCM, in two sites for each head, after location of the muscles by electrical stimulation. Investigations with provocative maneuvers were done after treatment. Eight patients (fourteen limbs) aged between 17 and 54 years old were included. One patient had previously unsuccessfully been treated by surgery. Mean follow up was 22.1 ± 21.2 months (6–74). Five patients had resolution of symptoms, during 70.6 ± 74.3 weeks (17–216). Two patients are currently still asymptomatic. Three patients relapsed. Adverse events were moderate systemic events (two patients) and subjective muscular weakness (two patients). Ankle brachial index, Doppler ultrasonography or tomography angiography improved or normalized in three patients, all successfully treated. Long-lasting resolution of symptoms in five patients could indicate that BoNT-A injections reduce functional compression. However, treatment failed in three patients. Continuation of the study with more patients may indicate whether BoNT-A injections could be a treatment of FPAES, which has no appropriate treatment as of today.

Mini-Open Posterior Compartment Release for Chronic Exertional Compartment Syndrome of the Leg

Chronic exertional compartment syndrome (CECS) is a well-recognized cause of leg pain in endurance athletes. Surgical fasciotomy for posterior leg CECS historically has inferior clinical results compared with anterior and lateral compartment release. Poor surgical technique with inadequate release may contribute to less reliable outcomes. In this Technical Note with accompanying video, we describe a mini-open approach for posterior CECS of the leg.

Magnetic resonance imaging of painful swollen legs in the emergency department: a pictorial essay.

Patients presenting with a painful swollen leg are not infrequently encountered at the emergency department and can pose a diagnostic dilemma for attending physicians. The potential causes of leg pain and swelling include trauma, infection, inflammation, and neurogenic, vascular, and iatrogenic conditions; with magnetic resonance imaging (MRI) being an important tool in evaluation. We describe the MRI features of various conditions causing painful swollen legs. We also discuss the differential diagnosis and the useful clinical and laboratory findings that radiologists should be aware of, in order to arrive at an accurate diagnosis.

Surgical Treatment of Chronic Exertional Compartment Syndrome in Pediatric Patients

Background: Chronic exertional compartment syndrome (CECS) is a cause of leg pain in running athletes and is treated with fasciotomy after failure of nonoperative management. CECS is being seen with increased frequency in younger patients. The demographics and outcomes of fasciotomy for CECS in pediatric patients, including risk factors for treatment failure, have not been described. Purpose: To describe characteristics of pediatric patients with CECS and determine surgical outcomes of the condition in this population. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed for patients 18 years and younger treated surgically for CECS with compartment release at a single institution from 1995 to 2014. Demographic and condition characteristics, operative procedure, postoperative course, and clinical outcomes were recorded for 286 legs of 155 patients. Compartment pressure testing using the Pedowitz criteria confirmed the diagnosis in all patients. Results: A total of 155 patients were included in the study (average patient age at presentation, 16.4 ± 1.38 years); 136 (88%) were female. All 155 patients presented with leg pain; of these patients, 8 (5%) also had neurologic symptoms, and 131 (85%) presented with bilateral symptoms requiring bilateral compartment release. Symptoms were chronic in nature, with duration over 1 year in 63% of patients. The primary sport was most commonly reported as running (25%), soccer (23%), or field hockey (12%); 50% of patients were multisport athletes. Of 286 legs, 138 (48%) had only anterior and/or lateral compartments released, while 84 (29.4%) had all 4 compartments released. Documented return to sport was seen in 79.5% of patients. Outcomes analysis was performed for 250 of 286 legs. Of these 250 legs, 47 (18.8%) had recurrent CECS requiring reoperation at a median of 1.3 years (interquartile range, 0.8-3.5) after initial compartment release. For each additional month between presentation and release, the odds of recurrence decreased by 12% (P = .04). Legs with only anterior and/or lateral compartment released had 3.4 times (95% CI, 1.29-9.14) the odds of reoperation compared with legs that had all 4 compartments released (P = .01). Twenty-eight of 250 legs (11.2%) had wound issues that resolved with nonoperative management. No wounds required repeat surgical management. Conclusion: CECS in pediatric patients most commonly occurs in adolescent females participating in running sports. Fasciotomy results in a 79.5% return-to-sports rate. Recurrence occurs in 18.8% of patients, more commonly in patients undergoing anterior and lateral release only.

Chronic compartment syndrome is an under-recognized cause of leg-pain

Chronic compartment syndrome is an under-recognized cause of leg-pain

Analysis of the Association Between an Insertion/Deletion Polymorphism Within the 3′ Untranslated Region of COL1A2 and Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is a common cause of leg pain and swelling and is commonly associated with varicose veins. It has significant socioeconomic consequences and is among the most common problems encountered in surgical practice. Although our current understanding of the pathogenesis of CVI is far from clear, there is a growing body of evidence suggesting a genetic contribution to the etiology of CVI. By analyzing 254 CVI cases and 508 healthy controls in a Chinese population, we used a candidate gene approach to evaluate the association between a 7-base pair insertion/deletion (indel) polymorphism (rs3917) in the 3' untranslated region (3'UTR) of the alpha-2 type I collagen gene (COL1A2) and CVI susceptibility. Logistic regression was used to analyze the association between rs3917 and CVI risk, adjusted for sex and age. Computational modeling was used to predict potential molecular mechanisms underlying the association. Logistic regression analysis revealed that subjects carrying indel or deletion/deletion genotypes had a significantly increased risk for CVI than individuals carrying insertion/insertion genotypes (adjusted odds ratio, 1.64; 95% confidence interval [CI], 1.10-2.45; P=0.010). Carrying the 7-base pair deletion allele was associated with a 1.60-fold risk for CVI (95% CI, 1.11-2.31; P=0.008). Computational modeling suggests that the rs3917 insertion allele lies within a predicted binding site (seed region) for microRNA-382 and that the deletion allele alters the affinity of microRNA-mRNA binding by disrupting the local structure of COL1A2 mRNA, presumably allowing for upregulated COL1A2 expression. Taken together, our data suggest that common genetic variations in COL1A2 may influence CVI risk, possibly through microRNA-382-mediated regulation. Replication of our studies in other populations will strengthen our understanding of this association.

Undescribed variation of the sciatic nerve

Piriformis muscle syndrome has been increasingly recognized as a cause of leg pain. Overuse, strain, or anatomical variations of the relationship between the nerve and the piriformis muscle are thought to be the underlying causes of the entrapment of the sciatic nerve. We report a previously undescribed variation found during a routine dissectionDuring a routine dissection of the left gluteal region of an adult male cadaver we observed a high division of the sciatic nerve and the presence of an accessory piriformis muscle. The sciatic nerve divided beneath the piriformis muscle and the common fibular nerve passed over the accessory piriformis muscle, whereas the tibial nerve reflected anteriorly to pass between the accessory piriformis and the superior gemellus muscle. Additionally, both nerves communicated with a side branch under the inferior border of the accessory piriformis muscle and the inferior gluteal nerve originated from the fibular nerve.Anatomical variations in the relationship between the piriformis muscle and the sciatic nerve may be present in up to 17% of the population. Six different variations have been described and none of them is similar to our description. Though complete understanding of the physiopathology of the piriformis muscle syndrome remains to be elucidated, knowledge of the possible anatomical variations may be useful for its adequate diagnosis and treatment.

The usefulness of ankle-brachial index as a screening test on peripheral artery occlusive disease in patients with low back and leg pain

The usefulness of ankle-brachial index as a screening test on peripheral artery occlusive disease in patients with low back and leg pain

The magnitude of intramuscular deoxygenation during exercise is an unreliable measure to diagnose the cause of leg pain

We measured intramuscular oxygenation in the anterior tibial muscle of 176 patients with exercise-induced leg pain by noninvasive near-infrared spectroscopy before, during, and after an exercise test that elicited the symptoms. Clinical investigation was performed after each test. Intramuscular pressure was measured in patients with nonconclusive findings. Chronic anterior compartment syndrome (CACS) was diagnosed in 47 patients, and other causes for the leg pain were diagnosed in 129 patients by clinical means. The mean level of oxygenation decreased to 33 ± 19% in patients with CACS and to 34 ± 19% in patients without CACS compared with baseline level (100%) at rest before exercise. The level of oxygenation was below 20% during the exercise test in 12 of 47 (26%) patients with CACS and in 30 of 129 (23%) patients without CACS. The time required for reoxygenation after the cessation of exercise was 61 ± 34 s in patients with CACS and 46 ± 20 s in patients without CACS (P < 0.05). We conclude that the magnitude of intramuscular deoxygenation during exercise is an unreliable measure to diagnose CACS. However, the time for reoxygenation returning to baseline level following an exercise test is a valuable adjunct in diagnosing CACS.