Diagnosis Of Exertional Compartment Syndrome Research Articles

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.

Endoscopic-Assisted Fascial Decompression for Forearm Exertional Compartment Syndrome: A Case Report and Review of the Literature

A case of chronic exertional compartment syndrome of the forearm treated with endoscopic-assisted fascial decompression is presented. The diagnosis of exertional compartment syndrome of the forearm was confirmed by direct measurement of intracompartmental pressures. Following endoscopic-assisted fascial decompression, the patient was able to begin rehabilitation therapy within 2weeks. There were no wound-related complications. The patient reported no recurrence of symptoms after returning to work requiring heavy lifting, and morbidity associated with open decompression was avoided. Endoscopic release is not an option in traumatic compartment syndrome, but a minimally invasive approach may be considered in cases of exertional compartment syndrome. Reports of endoscopic-assisted fascial decompression in exertional compartment syndrome of the forearm are relatively scarce. Confirmation of the safety and efficacy of these evolving techniques in the hand surgery literature remains important.

Imaging the microcirculatory proton fraction of muscle with diffusion-weighted echo-planar imaging

The diagnosis of exertional compartment syndrome is challenging. In this feasibility study, diffusion-weighted echo-planar magnetic resonance imaging was performed in human subjects to determine whether alterations in the circulating blood volume of muscle secondary to exercise or changes in compartment pressure could be visualized. The calf muscles of six subjects were studied before and after exercise and also during the application of external pressure to the calf. Gated, single-shot, diffusion-weighted echo-planar imaging (1.5 T) was implemented with signal averaging. Parametric images of the "perfusion" fraction (f) were generated, and regions of interest from anatomic compartments were analyzed. The precision of f was estimated by using propagation of error analysis. Parametric images depicted visible increases in the microcirculatory proton fraction (f) of calf muscle after exercise (mean change, +0.016) and visible decreases in f on the application of 40 mm Hg to the calf after exercise (mean change, -0.023). Mean changes in f were only significantly different from zero for the group, however, under conditions of applied pressure to the calf after exercise. Changes in f were not significantly different across muscle compartments. The error variance in f was approximately 0.01. Parametric images of f generated by diffusion-weighted echo-planar imaging may depict alterations in the circulating blood volume of muscle induced by exercise and changes in compartment pressure. The inherent imprecision of this technique, however, appears to limit its clinical utility.

Basic principles for measurement ofintramuscular pressure

We review historical and methodological approaches to measurements of intramuscular pressure (IMP) in humans. These techniques provide valuable measures of muscle tone and activity as well as diagnostic criteria for evaluation of exertional compartment syndrome. Although the wick and slit catheter techniques provide accurate measurements of IMP at rest, their value for exercise studies and diagnosis of exertional compartment syndrome is limited because of low frequency response and hydrostatic (static and inertial) pressure artifacts. Presently, most information on diagnosis of exertional compartment syndromes during dynamic exercise is available using the Myopress catheter. However, future research and clinical diagnosis using IMP can be optimized by the use of a miniature transducer-tipped catheter such as the Millar Mikro-tip.

The evaluation and treatment ofexertional compartment syndrome

Exertional compartment syndrome (ECS) is becoming increasingly recognized as a cause of exercise-induced legpain in the athletic population. Unfortunately, the pathophysiology is not clearly understood. The use of 31P-NMR has shown that ischemia is not a significant component of ECS because it is in the acute syndrome. A primary diagnosis can be made after a thorough history and physical examination. In a young patient with leg pain that is only exercise induced, reproducible and associated with a normal physical examination, a diagnosis of ECS is likely and does not need to be a diagnosis of exclusion. Confirmation with intracompartmental pressure measurement still remains the gold standard before further management. Nonoperative management is usually ineffective and fasciotomies of the affected leg(s) and compartment is the recommended treatment in the symptomatic patient. At our center, the use of a two-incision anterior and lateral compartment release, and a one-incision posterior compartment release has been very successful in returning athletes symptom free to their sporting level.

Ultrasound Evaluation of the Anterior Musculofascial Compartment of the Leg Following Exercise

An ultrasonic method is described to measure changes in width of the anterolateral leg compartment in its lower third following exercise. In 20 normal subjects, compartment widths increased an average of 8.6% following exercise, with joggers' compartments increasing 10.1%, as compared to 7.4% in nonjoggers. Control measurements of the compartment width in a cadaver leg showed excellent correlation with the ultrasound measurement. Following exercise, vascular responses and fluid transfers caused an increase in volume of the compartment contents, which is reflected in compartment widening. Because the compartment contents are usually contained by a complete but only moderately compliant wall, intracompartmental pressure will normally rise, and symptoms of a compartment syndrome will result. Diagnosis of exertional compartment syndrome in the leg has usually been made at clinical examination. Measurement of compartment width increase is intended to complement intracompartmental pressure and aid in differentiating the diagnosis of exertional compartment syndrome from shin splints, stress fracture, and tendonitis. Additionally, muscle atrophy, hypertrophy and growth can be recorded by the ultrasound technique.