Limb Compression Research Articles

Analysis and Treatment of Multiple Severe Venous Vascular Malformation Syndrome Combined with Coagulopathy.

Analysis and Treatment of Multiple Severe Venous Vascular Malformation Syndrome Combined with Coagulopathy.

Acute exposure to foot orthoses affects joint stiffness characteristics in recreational male runners

Commercially available foot orthoses are advocated for the treatment of chronic running injuries, such as patellofemoral pain, yet the mechanisms behind their effects are not well understood. This study aimed to examine the limb and joint stiffness characteristics when running with and without orthotics. Twelve recreational runners ran at 4.0 m/s. Limb stiffness was obtained using a spring-mass model of running by dividing the peak vertical ground reaction force (GRF) by the amount of limb compression. Knee and ankle joint stiffness’s were calculated by dividing the peak sagittal plane joint moment by the joint angular excursion. Differences between orthotic and non-orthotic running conditions were contrasted using paired samples t-tests. The results indicate that both peak knee extensor moment (orthotic = 2.74±0.57 and no-orthotic = 3.12±0.62 Nm/kg) and knee stiffness (orthotic = 5.56±1.08 and no-orthotic = 6.47±1.40 Nm/kg rad) were significantly larger when running without orthotics. This study may give further insight into the mechanical effects of commercially available foot orthoses. The current investigation provides some evidence to suggest that orthoses may be able to improve patellofemoral pathologies in recreational runners although further investigation is required.

Lower limb compression Doppler ultrasound (LLUS) in investigation of pregnant patients with suspected pulmonary embolism (PE): is it useful?

Background: Pregnancy is high-risk state for PE. Clinical assessment and d-dimer are unreliable indicators of PE in pregnancy. Radioisotope perfusion (Q) scan or computed tomographic pulmonary angiography (CTPA) pose a radiation burden to breast tissue and foetus. A screening LLUS may reduce further imaging and is hence recommended by current guidelines.

A Comparison Of High And Low Grade Compression Garments On Recovery From Damaging Exercise

The evidence to support the use of commercially available compression garments (CG) following damaging exercise is equivocal. It is possible that in some cases the degree of pressure exerted is not sufficient to be of physiological benefit. The pressure exerted by clinical grade CG is generally higher than commercially available CG and therefore might be more effective in enhancing recovery. PURPOSE: To identify whether higher vs lower pressure CG alter the recovery response following strenuous exercise. METHODS: Forty five subjects (n= 19 female, n= 26 male; mean ± SD age 30 ± 6 yrs; height 174.2 ± 9.4 cm; body mass 72.2 ± 11.9 kg) completed 100 drop jumps. Participants were then randomly assigned to either a LOW (8-17mmHg*), or HIGH (14-24mmHg*) compression treatment group, or a sham-ultrasound treatment group (SHAM). The LOW and HIGH groups wore lower limb compression tights for 72 hours following the exercise bout, whilst the SHAM group received a single treatment of 10 min sham ultrasound following the exercise. Perceived muscle soreness and maximal voluntary contraction (MVC) were assessed before exercise and 1, 24, 48 and 72 h post exercise. RESULTS: MVC data showed clearly that muscle damage was successfully induced. There was a group effect whereby the HIGH group recovered MVC faster than the SHAM group (p < 0.05); the HIGH group reached 99.9% of their baseline value at 72h wheras the sham-ultrasound group achieved 91.2% of their baseline values. The LOW group achieved 91.3% of their baseline MVC value, however there was no significant group effect for the LOW compression. There were no significant group effects or interaction effects for soreness (p > 0.05). CONCLUSION: There was evidence to suggest that lower limb compression garments that exert a higher level of compression (14-24mmHg*) can result in improved recovery of muscle function, but appear to be of limited value in resolving the soreness associated with exercise-induced muscle damage. Compression garments that exert lower levels of compression (8-17mmHg*) appear to have no benefit on indices of recovery. *average pressure for the group measured at the thigh and calf respectively.

Pharmacokinetics characteristics of dexamethasone in Crush syndrome model rats

Crush syndrome (CS) is characterized by ischemia/reperfusion-induced rhabdomyolysis and subsequent systemic inflammation and has a high mortality rate, even when treated with conventional therapy. In previous studies, we demonstrated that treatment of rats with acute lethal CS using dexamethasone (DEX) had therapeutic effects in laboratory findings and improved the clinical course of CS. However, because the application of DEX in CS therapy is unknown, evaluation of the pharmacokinetic parameters of DEX was considered essential to support its clinical use. Here, we investigated the pharmacokinetic characteristics of DEX in a rat model of CS. Anesthetized rats were subjected to bilateral hind limb compression using rubber tourniquets for 5 h, followed by reperfusion for 0 to 24 h. Rats were divided randomly into 4 groups: saline-treated sham (S) and CS groups and 5.0 mg/kg DEX-treated S (S-DEX) and CS (CS-DEX) groups. Blood and tissue samples were collected for HPLC analysis. In the CS-DEX group, the pharmacokinetic parameters of the area under the concentration-time curve, mean residence time, and distribution volume levels increased significantly compared to the S-DEX group, whereas total body clearance, elimination rate constant, and renal clearance levels decreased significantly. Moreover, decrease of muscle tissue DEX concentration and of CYP3A activity were observed in the CS-DEX group. These results show the pharmacokinetic characteristics of DEX in the rat CS model and support the potential use of DEX in disaster medical care.

Comparison of three methods of calculating strain in the mouse ulna in exogenous loading studies

Axial compression of mouse limbs is commonly used to induce bone formation in a controlled, non-invasive manner. Determination of peak strains caused by loading is central to interpreting results. Load-strain calibration is typically performed using uniaxial strain gauges attached to the diaphyseal, periosteal surface of a small number of sacrificed animals. Strain is measured as the limb is loaded to a range of physiological loads known to be anabolic to bone. The load-strain relationship determined by this subgroup is then extrapolated to a larger group of experimental mice. This method of strain calculation requires the challenging process of strain gauging very small bones which is subject to variability in placement of the strain gauge. We previously developed a method to estimate animal-specific periosteal strain during axial ulnar loading using an image-based computational approach that does not require strain gauges. The purpose of this study was to compare the relationship between load-induced bone formation rates and periosteal strain at ulnar midshaft using three different methods to estimate strain: (A) Nominal strain values based solely on load-strain calibration; (B) Strains calculated from load-strain calibration, but scaled for differences in mid-shaft cross-sectional geometry among animals; and (C) An alternative image-based computational method for calculating strains based on beam theory and animal-specific bone geometry. Our results show that the alternative method (C) provides comparable correlation between strain and bone formation rates in the mouse ulna relative to the strain gauge-dependent methods (A and B), while avoiding the need to use strain gauges.

The effects of reciprocal inhibition on motor function and brain functional network connectivity of stroke patients

Objective To investigate the effects of reciprocal inhibition on motor function connectivity in the brains of stroke patients.Methods Thirty patients with stroke were randomly divided into a treatment group (n =15) and a control group (n =15).The control group underwent normal limb positioning,medium frequency electrotherapy,circulated compression of the limbs,etc.The treatment group received conventional rehabilitation treatment plus reciprocal inhibition treatment for 30 min daily,6 times a week for 4 weeks.All of the patients were assessed before and after treatment using the Canadian neurological scale (CNS),the Frenchay activities index (FAI),the motricity index (MI) and functional magnetic resonance imaging of the motor cortex in a resting state (rs-fMRI).Results In both groups the average CNS,FAI and MI scores improved significantly.Compared with the control group,the changes in FAI and MI scores in the treatment group improved significantly more.The coefficient of functional connectivity of the bilateral motor cortex decreased significantly after treatment in both groups.In the treatment group the motor cortex functional connectivity correlated significantly with the improvements in MI scores.Conclusions Reciprocal inhibition can accelerate the improvement of extremity motor function and ability in the activities of daily living significantly after stroke.It reduces functional connectivity in the bilateral motor cortex in ways significantly correlated with improvements in motor function. Key words: Reciprocal inhibition; Resting-state functional magnetic resonance imaging; Stroke

Influence of Compression Garments on Recovery After Marathon Running

Strenuous physical activity can result in exercise-induced muscle damage. The purpose of this study was to investigate the efficacy of a lower limb compression garment in accelerating recovery from a marathon run. Twenty four subjects (female, n = 7; male, n = 17) completed a marathon run before being assigned to a treatment group or a sham treatment group. The treatment group wore lower limb compression tights for 72 hours after the marathon run, the sham treatment group received a single treatment of 15 minutes of sham ultrasound after the marathon run. Perceived muscle soreness, maximal voluntary isometric contraction (MVIC), and serum markers of creatine kinase (CK) and C-reactive protein (C-RP) were assessed before, immediately after, and 24, 48, and 72 hours after the marathon run. Perceived muscle soreness was significantly lower (p ≤ 0.05) in the compression group at 24 hours after marathon when compared with the sham group. There were no significant group effects for MVIC, CK, and C-RP (p > 0.05). The use of a lower limb compression garment improved subjective perceptions of recovery; however, there was neither a significant improvement in muscular strength nor a significant attenuation in markers of exercise-induced muscle damage and inflammation.

Effectiveness of Carpal Tunnel Syndrome Rehabilitation after Endoscopic Versus Open Surgical Release

BACKGROUND. Carpal tunnel syndrome is a common upper limb compression neuropathy. Postoperative rehabilitation improves the function of the limb. The aim of this study was to assess the effects of rehabilitation in patients who had undergone endoscopic vs. open surgical carpal tunnel release. MATERIAL AND METHODS. Twenty-six patients were divided into endoscopy (E) and open surgery (K) groups. The following parameters were assessed after rehabilitation: two-point discrimination by fingertips of the operated hand, ranges of motion of joints of the hand, circumferences of the radiocarpal and metacarpo pha langeal joints and the severity of pain and other symptoms. RESULTS. The groups differed regarding the severity of symptoms (numbness), joint circumferences and tactile sensation in fingertips I-IV. The mean values of these parameters were significantly higher in group K compared to group E. In group E, rehabilitation decreased severity of pain and other symptoms and increased the ranges of motion. Recovery of two-point discrimination by fingertips I-IV was also observed. Group K patients showed the greatest improvement in the range of motion. Pain intensity decrease did not reach statistical significance. The two-point discrimination test demonstrated better tactile sensation, but the mean distance between caliper points for particular fingers still showed reduced two-point discrimination ability. CONCLUSIONS. 1. Rehabilitation improved hand function in patients from groups that operated on using different techniques of median nerve release. 2. Rehabilitation resulted in improved innervation density, which was reflected by changes in two-point discrimination scores in fingertips in the operated hand of patients from both groups. 3. Great er improvement was achieved in the pa tients who had undergone an endoscopic procedure.

Postoperative Blood Loss Prevention in Total Knee Arthroplasty

Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.

Влияние силы компрессии конечности на выраженность морфологических изменений при синдроме длительного сдавления

Влияние силы компрессии конечности на выраженность морфологических изменений при синдроме длительного сдавления

Atraumatic painless compartment syndrome

Acute compartment syndrome is a time-sensitive diagnosis and surgical emergency because it poses a threat to life and the limbs. It is defined by Matsen et al (Surg Gynecol Obstet. 1978;147(6):943–949) as "a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space." The most common cause of compartment syndrome is traumatic injury. A variety of other conditions such as vascular injuries, bleeding disorders, thrombosis, fasciitis, gas gangrene, rhabdomyolysis, prolonged limb compression, cellulitis, and nephrotic syndrome may also cause compartment syndrome. Patients who are elderly, have preexisting nerve damage, or have psychopathology may have an atypical presentation. This case highlights the first report of a 75-year-old woman who developed painless bilateral compartment syndrome in the absence of traumatic injury.

Limb compression induces multi-system genetic damage in rats

Muscle crush injury is a common trauma in the modern society after as a result of mass disasters after penetration into muscle by high-velocity projectiles, blunt external trauma, or by gravity during prolonged immobilization in comatose patients after head trauma, alcoholic or drug overdose. However, the underlying mechanisms linking these alterations are still not fully understood, especially in acute phase. The aim of this study was to analyze genomic instability in multiple organs of rats after acute muscle injury by means of single cell gel (comet) assay. Rats were randomly distributed into three groups (n=6 each group): control group and experimental groups: sacrificed 6h as 12h after muscle compression. These results indicate genetic damage in peripheral blood cells as depicted by tail moment results. DNA breakage was also detected in liver, lung and kidney cells after acute muscle injury for two times evaluated. Heart cells showed genetic damage after 12h following muscle compression. Taken together, our results suggest that acute muscle injury induces genomic damage in multiple organs of Wistar rats. This novel finding offers new insights into the underlying mechanisms of the relationship between acute crush muscle injury and clinical manifestations that can occur during limb compression.

Acute lethal crush-injured rats can be successfully rescued by a single injection of high-dose dexamethasone through a pathway involving PI3K-Akt-eNOS signaling

Crush syndrome (CS) is characterized by ischemia/reperfusion-induced rhabdomyolysis and the subsequent onset of systemic inflammation. CS is associated with a high mortality, even when patients are treated with conventional therapy. We hypothesized that treatment of lethal CS rat model with dexamethasone (DEX) have therapeutic effects on the laboratory findings and clinical course and outcome. To create a CS model, anesthetized rats were subjected to bilateral hind limb compression with rubber tourniquets for 5 hours and randomly divided into three groups as follows: saline-treated CS group, CS groups treated with low (0.1 mg/kg) and high doses (5.0 mg/kg) of DEX. Saline for the CS group or DEX for the DEX-treated CS groups was intravenously administered immediately before reperfusion. Under continuous monitoring and recording of arterial blood pressures, blood and tissue samples were collected for histologic and biochemical analysis at designated period before and after reperfusion. Ischemic compression of rat hind limbs reduced the nitrite content in the crushed muscle, and the subsequent reperfusion induced reactive oxygen species-mediated circulatory collapse and systemic inflammation, finally resulting in a mortality rate of 76% by 48 hours after reperfusion. A single injection of high-dose DEX immediately before reperfusion activated endothelial nitric oxide synthase (eNOS) by sequential phosphorylation through the nongenomic phosphoinositide 3-kinase (PI3K)-Akt-eNOS signaling pathway. DEX also exhibited anti-inflammatory effects by modulating proinflammatory and anti-inflammatory mediators, consequently suppressing myeloperoxidase activities and subsequent systemic inflammation, showing a complete recovery of the rats from lethal CS. These results indicate that high-dose DEX reduces systemic inflammation and contributes to the improved survival rate in a rat CS model.

Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients

Optimal thromboprophylaxis for patients at risk of bleeding remains uncertain. This meta-analysis assessed whether intermittent pneumatic compression (IPC) of the lower limbs was effective in reducing venous thromboembolism and whether combining pharmacological thromboprophylaxis with IPC would enhance its effectiveness. Two reviewers searched MEDLINE, EMBASE, and the Cochrane controlled trial register (1966-February 2013) for randomized, controlled trials and assessed the outcomes and quality of the trials independently. Trials comparing IPC with pharmacological thromboprophylaxis, thromboembolic deterrent stockings, no prophylaxis, and a combination of IPC and pharmacological thromboprophylaxis were considered. Trials that used IPC <24 hours or compared different types of IPC were excluded. A total of 16 164 hospitalized patients from 70 trials met the inclusion criteria and were subjected to meta-analysis. IPC was more effective than no IPC prophylaxis in reducing deep vein thrombosis (7.3% versus 16.7%; absolute risk reduction, 9.4%; 95% confidence interval [CI], 7.9-10.9; relative risk, 0.43; 95% CI, 0.36-0.52; P<0.01; I(2)=34%) and pulmonary embolism (1.2% versus 2.8%; absolute risk reduction, 1.6%; 95% CI, 0.9-2.3; relative risk, 0.48; 95% CI, 0.33-0.69; P<0.01; I(2)=0%). IPC was also more effective than thromboembolic deterrent stockings in reducing deep vein thrombosis and appeared to be as effective as pharmacological thromboprophylaxis but with a reduced risk of bleeding (relative risk, 0.41; 95% CI, 0.25-0.65; P<0.01; I(2)=0%). Adding pharmacological thromboprophylaxis to IPC further reduced the risk of deep vein thrombosis (relative risk, 0.54; 95% CI, 0.32-0.91; P=0.02; I(2)=0%) compared with IPC alone. IPC was effective in reducing venous thromboembolism, and combining pharmacological thromboprophylaxis with IPC was more effective than using IPC alone.

Leukocyte infiltration in lung, muscle, and liver after limb compression in rats

Muscle crush injury is associated with systemic manifestations known as crush syndrome. A systemic inflammatory response syndrome may be triggered by isolated crush injury. Using myeloperoxidase (MPO) activity and plasma fatty acid composition, we investigated the inflammatory response in distant organs after isolated limb compression in rats. Male Wistar rats were submitted to 1h of hind limb compression by a latex ribbon. Myeloperoxidase activity was measured in muscle, liver, and lung at progressive times (1, 2 or 4h) after bandage release. Plasma fatty acid composition was evaluated as an indirect measure of oxidative stress. The liver and hind limb muscles showed a transient increase in MPO activity. Pulmonary MPO activity, otherwise, increased progressively throughout the study and reached statistically significant values at 4h when compared to all other groups (p<0.05). Plasma levels of unsaturated fatty acids decreased gradually after decompression (p<0.05 compared to controls after 4h). Blunt traumatic muscle compression was associated with rapid and transient muscle and liver inflammatory cell infiltration but otherwise, polymorphonuclear cells showed progressive aggregation in lungs. The plasmatic unsaturated index decreased throughout the 4h after muscle release. We demonstrated that limb compression was associated with oxidative stress and distant inflammatory responses. Progressive inflammatory cell infiltration in lungs could be related with the delayed systemic adverse responses found after crush injury.

Inferior vena cava thrombosis: A review of current practice

Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow's triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.

Efficacy of Lower Limb Compression in the Management of Vasovagal Syncope—Randomized, Crossover Study

Vasovagal syncope (VS) is the most prevalent cause of transient loss of consciousness. The treatment consists of lifestyle modifications and pacemaker in some patients. The purpose of this study is to evaluate the effect of measures to compress the lower limbs in patients with recurrent episodes of VS submitted to the tilt-test (TT). Twenty patients, average age 30.5 years (15-75), 13 (65%) female, with a clinical diagnosis of VS and previous TT with a positive result and who had at least one episode of syncope during the last year, were included in this placebo-controlled randomized crossover study. The patients underwent two consecutive TT, at a 1-hour interval, with and without compression by pneumatic compression boots with 40 mmHg at the heels and 30 mmHg for the legs. The blood pressure (BP) and heart rate (HR) of these patients were monitored continuously. The outcome assessors were blinded. The results of the TT were positive in 13 (65%) of the patients in the control groups and in two (10%) of the patients with compression (P < 0.0001). Throughout the test, the systolic BP was not different among the groups. On the other hand, the HR measures showed a difference only in the tilted position at 2 minutes, of 73 ± 16 beats per minute (bpm) in the control group and of 69 ± 16 bpm (P = 0.047) in the compression group. Compression of the lower limbs is very effective to render the TT negative in patients with a diagnosis of VS.

What influence does intermittent pneumatic compression of the lower limbs intraoperatively have on core hypothermia?

Intermittent pneumatic compression (IPC) devices have been widely used for thrombosis prophylaxis in laparoscopic colorectal surgery. However, periodic compression using an IPC device may inject augmented boluses of cool blood from the lower limbs into the central circulation repetitively, thereby causing a reduction in core temperature. The authors therefore conducted a prospective, randomized, double-blind, controlled study to compare the effects of intraoperative IPC on core temperature in patients undergoing laparoscopic colorectal surgery. For this study, 56 patients ages 18-60 years and scheduled to undergo laparoscopic resection for colorectal cancer under general anesthesia were randomly assigned to receive either no IPC (control group) or calf-thigh-length IPC in both legs using the SCD Express (IPC group). Anesthetic, thermal, and pneumoperitoneum management were standardized. Esophageal temperature, as an indicator of core temperature, was measured at 15-min intervals for 2 h after induction of anesthesia. A total of 47 subjects (23 control and 24 IPC subjects) were included in the analysis. The core temperature drop in the IPC group was significantly greater than in the control group, starting from 45 min after induction of anesthesia (P < 0.05). As a result, the total temperature drop during the 2-h study period was significantly greater in the IPC group (1.2 ± 0.3 °C) than in the control group (0.9 ± 0.3 °C) (P = 0.004). Because intraoperative application of IPC carries an increased risk of a core temperature drop, appropriate temperature monitoring and active thermal management are required for surgical patients receiving IPC.

Effect of gaiters on muscle pump activity in healthy volunteers

Exercise of the leg with external limb compression has been reported to be useful for preventing and reducing leg oedema. The aim of this study was to investigate the effects of leg gaiters on calf muscle pump activity. Continuous measurements of the interface pressure at the leg during exercise and determination of the femoral venous velocity at the groin during exercise were carried out in healthy volunteers with elastic stockings alone, leg gaiters alone and gaiters over the elastic stockings. The greatest pressure difference between muscle contraction and relaxation during exercise was observed when gaiters were applied over the elastic stockings at the calf. Gaiters alone without elastic stockings led to a significantly greater pressure difference between muscle contraction and relaxation during exercise than elastic stockings alone (P < 0.01). A significantly higher value of the peak flow velocity of the femoral vein was observed with the combined use of gaiters and elastic stockings than the single use of elastic stockings. Leg gaiters have a beneficial effect of augmenting venous femoral blood flow during calf muscle pump activity in volunteers with a normal valve function of leg veins.