The significance of intracompartmental pressures in diagnosing chronic exertional compartment syndrome - A metaanalysis of studies monitoring dynamic anterior compartment pressures during exercise

1999 ◽  
Vol 102 (4) ◽  
pp. 267-277 ◽  
Author(s):  
C. Willy ◽  
J. Sterk ◽  
H.-U. Völker ◽  
S. Benesch ◽  
H. Gerngroß
Keyword(s):  
Compartment Syndrome ◽  
Anterior Compartment ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Compartment Pressures

scholarly journals Forearm compartment pressures and grip strength in elite motorbike racers with chronic exertional compartment syndrome

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dominic P. O’Dowd ◽  
Heike Romer ◽  
Richard Hughes ◽  
Noel Harding ◽  
Samantha Ball ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Grip Strength ◽  
Exercise Programme ◽  
Post Exercise ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
The Mean ◽  
Compartment Pressures ◽  
Forearm Flexor

Abstract Background Remarkably little research has been published on chronic exertional compartment syndrome (CECS) of the forearm. This study investigated forearm flexor compartment pressure pre- and post-exercise in elite motorbike racers clinically diagnosed with CECS and assessed their grip strength before and after arm pump exercise. Methods Elite motorbike riders with a clinical diagnosis of CECS of the right forearm when racing were recruited during the opening rounds of a British Superbike season. Their grip strength and forearm flexor compartment pressures were measured before and after a set exercise programme. Results Of the 11 riders recruited to the study, 10 completed the full testing regime. The mean pre-exercise forearm compartment pressures [11.7 mmHg (range 7–17 mmHg)] significantly increased post-exercise [30.5 mmHg (range 15–45 mmHg)], with a mean increase of 18.80 mmHg (P < 0.0001). The mean pre-exercise grip strength [50.61 mmHg (range 37–66.7 mmHg)] decreased post-exercise to [35.62 mmHg (range 17.1–52.5 mmHg)], a mean decrease of 14.99 mmHg (P < 0.0001). Conclusion There is a statistically significant increase in the forearm flexor compartment pressures in elite motorbike racers with CECS, but with marked variability of these values. Grip strength decreases statistically significantly following onset of symptoms of CECS of the forearm.

Surgical outcomes for chronic exertional compartment syndrome following improved diagnostic criteria

2019 ◽  
Vol 166 (E) ◽  
pp. e17-e20 ◽  
Author(s):  
Christopher Simpson ◽  
D Roscoe ◽  
S Hughes ◽  
D Hulse ◽  
H Guthrie
Keyword(s):  
Compartment Syndrome ◽  
Diagnostic Criteria ◽  
Clinical Symptoms ◽  
Diagnostic Testing ◽  
Rank Test ◽  
Anterior Compartment ◽  
Chronic Exertional Compartment Syndrome ◽  
Significant Difference ◽  
Exertional Compartment Syndrome ◽  
The Impact

IntroductionChronic exertional compartment syndrome (CECS) presents with pain during exercise, most commonly within the anterior compartment of the lower limb. A diagnosis is classically made from a typical history and the measurement of intramuscular compartmental pressure (IMCP) testing. Improved, more specific diagnostic criteria for IMCP testing allow clinicians to now be more certain of a diagnosis of CECS. Outcomes following surgical treatment in patients diagnosed using these more robust criteria are unknown.MethodsAll patients undergoing fasciectomy for anterior compartment CECS at a single rehabilitation unit were identified between 2014 and 2017. Wilcoxen signed-rank test was used to compare military fitness grading and paired t-test was used to compare Foot and Ankle Ability Measure, FAAM Sport Specific and Exercise-Induced LimbPain-G outcome measures, presurgery and postsurgery.ResultsThere was a significant difference in fitness grading between presurgical and postsurgical intervention (Z = −2.68, p < 0.01) with 46 % of patients improving their occupational medical grading. All secondary measures of outcome, looking at clinical symptoms, also improved.ConclusionAlmost half of the patients undergoing fasciectomy, following diagnosis using more specific criteria, will have an improvement in occupational medical grading. These outcomes represent the lower end of those reported in civilian populations. This is likely a result of a combination of factors, most notably the different diagnostic criteria followed and the more stringent criteria applied to military occupational grading, compared with civilian practice. Further work is now required to evaluate the impact of differing rehabilitation regimes on postoperative patients identified through this more specific diagnostic testing.

scholarly journals Chronic Exertional Compartment Syndrome of the Hand: Case Report and Literature Review

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. NP43-NP45 ◽  
Author(s):  
C. Liam Dwyer ◽  
Maximillian C. Soong ◽  
N. George Kasparyan
Keyword(s):  
Compartment Syndrome ◽  
Ambulatory Surgery ◽  
Rare Condition ◽  
Chronic Exertional Compartment Syndrome ◽  
Patient Reported ◽  
Exertional Compartment Syndrome ◽  
Muscle Compartment ◽  
Compartment Pressures ◽  
Surgery Center

Background: Chronic exertional compartment syndrome (CECS) is characterized by activity-induced pain, swelling, and decreased muscle function due to increased pressure and decreased circulation within a confined muscle compartment. Although well-known to occur in the leg, involvement of the hand has rarely been reported in the literature. Methods: We present a 44 year old male with CECS involving bilateral thenar and hypothenar compartments. Symptoms were reproduced on exam by driving screws into wood with a screwdriver. Elevated compartment pressures were confirmed with a hand-held digital device which employs a rigid needle that is readily directed to specific compartments. Results: Selective releases of the thenar and hypothenar compartments were performed under local anesthesia and forearm tourniquet in the ambulatory surgery center. At 3-month follow-up, the patient reported full use of his right hand, including woodworking, with excellent relief of symptoms. At 5 months postoperatively, he underwent identical surgical releases on the contralateral left side, with similar relief. Conclusions: CECS of the hand is a rare condition. Our case is unique among prior reports with regard to pattern of compartment involvement, as well as provocative maneuvers and compartment testing methods employed. This report should help foster clinical suspicion, facilitate diagnosis, and demonstrate success of targeted surgical treatment.

scholarly journals Superficial Peroneal Nerve Injury Risk During a Semiblind Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg: An Anatomical and Clinical Study

2018 ◽  
Vol 40 (3) ◽  
pp. 343-351 ◽  
Author(s):  
Johan A. de Bruijn ◽  
Aniek P. M. van Zantvoort ◽  
Henricus Pieter Hubert Hundscheid ◽  
Adwin R. Hoogeveen ◽  
Joep A. W. Teijink ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Case Series ◽  
Superficial Peroneal Nerve ◽  
Anterior Compartment ◽  
Chronic Exertional Compartment Syndrome ◽  
Sensory Deficits ◽  
Clinical Series ◽  
Exertional Compartment Syndrome

Background: Up to 8% of patients who underwent a fasciotomy for leg anterior chronic exertional compartment syndrome (ant-CECS) report sensory deficits suggestive of iatrogenic superficial peroneal nerve (SPN) injury. In the current study we aimed to thoroughly assess the risk of SPN injury during a semiblind fasciotomy of the anterior compartment using 2 separate approaches. Methods: A modified semiblind fasciotomy of the anterior compartment was performed via a longitudinal 2-cm skin incision 2 cm lateral of the anterior tibial crest halfway along the line fibular head-lateral malleolus both in cadaver legs and in patients with ant-CECS. In the cadaver legs, the skin was removed after the procedure and possible SPN injuries and spatial relationships between the SPN and the opened fascia were studied. Between January 2013 and December 2016, 64 ant-CECS patients who underwent a fasciotomy of the anterior compartment were prospectively followed. Iatrogenic SPN injuries were assessed using questionnaires and physical examinations. Results: Macroscopic SPN nerve injury was not observed in any of the 9 cadaver legs. In 8 specimens, the SPN was located at least 5 mm posterolateral to the opened fascia. In 1 specimen, an undamaged SPN branch crossed the operative field in a ventral plane. De novo sensory deficits suggestive for iatrogenic SPN injury were not observed in any of the 64 patients (120 legs; 36 females; median age, 22 years) who underwent a fasciotomy of the anterior compartment. Conclusion: The proposed semiblind fasciotomy for treatment of ant-CECS was not associated with SPN injury in either the cadaveric study or our clinical series. Level of Evidence: Level IV, case series.

scholarly journals Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989010 ◽  
Author(s):  
Antonia P.M. van Zantvoort ◽  
Henricus P.H. Hundscheid ◽  
Johan A. de Bruijn ◽  
Adwin R. Hoogeveen ◽  
Joep A.W. Teijink ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Case Series ◽  
Lateral Compartment ◽  
Leg Pain ◽  
Intracompartmental Pressure ◽  
Level Of Evidence ◽  
Anterior Compartment ◽  
Chronic Exertional Compartment Syndrome ◽  
Skin Sensation ◽  
Exertional Compartment Syndrome

Background: Chronic exertional compartment syndrome (CECS) mostly occurs in the anterior or deep posterior compartments (ant-CECS and dp-CECS, respectively) of the leg. It is generally accepted that CECS of the third or lateral compartment (lat-CECS) always occurs together with ant-CECS. However, whether exertional leg pain (ELP) can be caused by an isolated form of lat-CECS is unknown. Purpose: To determine the existence of isolated lat-CECS and study whether history taking and a physical examination aid in discriminating between different subtypes of CECS. Study Design: Case series; Level of evidence, 4. Methods: Patients were eligible for this single-center study, conducted between January 2013 and February 2018, if they reported anterolateral ELP and completed a questionnaire scoring the frequency and intensity of pain, tightness, cramps, muscle weakness, and paresthesia during rest and exercise. They were asked to mark areas of altered foot skin sensation, if present, on a drawing. All patients underwent a dynamic intracompartmental pressure (ICP) measurement of the anterior and lateral compartments simultaneously. The diagnosis of CECS was confirmed by elevated ICP (Pedowitz criteria). There were 3 patient groups: (1) isolated ant-CECS with elevated ICP in the anterior compartment and normal ICP in the lateral compartment, (2) isolated lat-CECS with elevated ICP in the lateral compartment but normal ICP in the anterior compartment, and (3) ant-/lat-CECS with elevated ICP in both the anterior and lateral compartments. Results: A total of 73 patients with anterolateral ELP fulfilled study criteria (isolated ant-CECS: n = 26; isolated lat-CECS: n = 5; ant-/lat-CECS: n = 42). Group differences were not observed regarding age (isolated ant-CECS: median, 26 years [range, 13-68 years]; isolated lat-CECS: median, 20 years [range, 17-63 years]; ant-/lat-CECS: median, 28 years [range, 17-57 years]; χ2 (2) = 0.466; P = .79), sex (isolated ant-CECS: 50% male; isolated lat-CECS: 40% male; ant-/lat-CECS: 62% male; P = .49), or bilateral symptoms (isolated ant-CECS: 54%; isolated lat-CECS: 80%; ant-/lat-CECS: 69%; P = .40). However, cramps at rest were present in a portion of the patients with isolated ant-CECS (38%) and ant-/lat-CECS (57%) but not in those with isolated lat-CECS ( P = .032). Patient drawings of altered foot skin sensation did not contribute to the diagnosis ( P = .92). ICP values after provocation were all lower in patients with isolated ant-CECS and isolated lat-CECS compared with those with ant-/lat-CECS ( P < .05). Conclusion: Seven percent of patients with CECS and anterolateral ELP who had symptoms due to isolated lat-CECS in the presence of normal muscle pressure in the anterior compartment.

scholarly journals A Retrospective Chart Review to Examine Intra-Compartment Pressures and Post-Operative Outcomes of Chronic Exertional Compartment Syndrome

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0014
Author(s):  
Jacob Brower ◽  
David M. Shuster ◽  
Nicholas A. Cheney ◽  
Brian C. Clark
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Blood Supply ◽  
Surgical Outcomes ◽  
Positive Trend ◽  
Chronic Exertional Compartment Syndrome ◽  
Post Operative Pain ◽  
Exertional Compartment Syndrome ◽  
Compartment Pressures ◽  
Pain Improvement

Category: Other Introduction/Purpose: Chronic exertional compartment syndrome (CECS) is defined as reversible, insufficient blood supply to a fascial compartment’s contents. Patients with this condition have abnormally elevated pressures within specific fascial compartments, causing decreased blood flow to that area. This temporary loss of blood supply produces a feeling of tightness in the affected muscles, pain, and possibly local paresthesia. Surgical treatment involves a fasciotomy, which releases the implicated compartment’s fascia. This procedure creates additional space for muscle expansion and more adequate blood supply to the appropriate tissues.The purpose of this study is to review the surgical outcomes of patients diagnosed with lower extremity CECS whom received a fasciotomy, assessing correlations between resting intramuscular compartment pressures and surgical outcomes. Methods: A retrospective chart analysis was performed of the senior author’s patients between January 1st, 2013 and June 30th, 2019. Patients included in this study presented with symptoms consistent with lower extremity CECS and had the diagnosis confirmed, either unilaterally or bilaterally, via the resting intramuscular pressure cutoff (>=15 mmHg) outlined by the Pedowitz criteria. These patients subsequently received fasciotomies for the syndrome. Results: Out of the 37 patients included in this study, 30 (81.1%) reported improvement in their post-operative pain scores. There was a trend (P > 0.1523) between resting intra-compartment pressures and post-operative pain improvement. Conclusion: Our study suggests a positive trend between higher resting intra-compartment pressures and post-operative pain improvement. Due to the limited number of study participants, no correlations could be determined. However, this data is significant because it demonstrates the importance of the Pedowitz diagnostic criteria, as it is the first study showing a relationship between the resting pressure criteria and surgical outcomes. Further research is necessary to determine if there is a correlation between higher intramuscular pressures and positive surgical outcomes.

Sign in / Sign up

Export Citation Format

Share Document