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.

Revision Surgery for Exertional Anterior Compartment Syndrome of the Lower Leg

2005 ◽  
Vol 33 (7) ◽  
pp. 1040-1047 ◽  
Author(s):  
Anthony A. Schepsis ◽  
Mark Fitzgerald ◽  
Robert Nicoletta
Keyword(s):  
Compartment Syndrome ◽  
Revision Surgery ◽  
Peroneal Nerve ◽  
High Pressures ◽  
Case Series ◽  
Pressure Measurements ◽  
Superficial Peroneal Nerve ◽  
Anterior Compartment ◽  
Satisfactory Outcome

Background Recurrent symptoms or failure after fasciotomy for exertional anterior compartment syndrome is not uncommon. Hypothesis Symptoms from high compartment pressures can be secondary to involvement of the entire compartment or to localized constrictions from postsurgical fibrosis, as well as to entrapment of the superficial peroneal nerve. Study Design Case series; Level of evidence, 4. Methods Eighteen patients who underwent revision surgery for exertional anterior compartment syndrome were available for follow-up. All were athletes who had either a failure or a recurrence of symptoms at a mean of 23.5 months (range, 8-54 months) after the index fasciotomy. Pressure measurements using a slit catheter at rest, at 1 minute postexercise, and at 5 minutes postexercise were performed in 2 places within the compartment: in the area of the previous incision and in the proximal muscle belly of the tibialis anterior. Surgical technique consisted of a 2-incision approach with partial fasciectomy, exploration and decompression of the superficial peroneal nerve, and excision of all fibrotic tissue. An objective examination and a comprehensive subjective questionnaire previously described were performed at a mean follow-up of 42 months (range, 22-67 months). Results Sixty percent of patients had abnormal pressures only in a localized area, whereas 40% had high pressures throughout the compartment. Eight of 18 (44%) patients had symptoms, signs, and surgical findings of entrapment of the superficial peroneal nerve. At follow-up, 72% of patients had a satisfactory outcome (5 excellent, 8 good), and 28% had an unsatisfactory outcome for intense running sports (4 fair, 1 poor), although 3 patients with the fair results reported improvement with low-level activity. All 8 patients with documented peroneal nerve entrapment had a satisfactory outcome. Conclusion Symptoms from high pressures can be secondary to involvement of the entire compartment or localized to a certain area from postsurgical fibrosis. Pressure measurements should be performed in at least 2 separate areas.

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 forearm: a case series of 12 patients treated with fasciotomy

2011 ◽  
Vol 36 (5) ◽  
pp. 413-419 ◽  
Author(s):  
J. S. Brown ◽  
P. C. Wheeler ◽  
K. T. Boyd ◽  
M. R. Barnes ◽  
M. J. Allen
Keyword(s):  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Case Series ◽  
Chronic Exertional Compartment Syndrome ◽  
Catheter Technique ◽  
Percentage Improvement ◽  
Patient Reported ◽  
Exertional Compartment Syndrome ◽  
Outcome Of Surgery

Chronic exertional compartment syndrome of the forearm is rare in the published literature. We report the outcome of a series of 12 patients treated with fasciotomy over a 14 year period. All patients underwent dynamic intra-compartmental pressure testing using a slit catheter technique before surgery. Raised intra-compartmental pressures on exercise, typical symptoms and the absence of other diagnoses were criteria for offering surgical intervention. The superficial flexor, deep flexor and extensor compartments were released. Median follow-up was 9.5 years (range 7 months to 12 years). Median patient-reported percentage improvement after surgery was 88% (range 0%–100%). Median time to return to full activity was 9 weeks. Eleven out of 12 patients were satisfied, very satisfied or extremely satisfied with the outcome of surgery. Fasciotomy can be an effective treatment for chronic exertional compartment syndrome of the forearm.

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