scholarly journals Microdialysis for chronic exertional compartment syndrome: a pilot study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Heinz Lohrer ◽  
Jochen Klein ◽  
Tanja Nauck ◽  
Tobias Schönberg
Keyword(s):  
Pilot Study ◽  
Compartment Syndrome ◽  
Level Of Evidence ◽  
Chronic Exertional Compartment Syndrome ◽  
Control Subjects ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
Healthy Control ◽  
Exercise Induced ◽  
And Control

Abstract Background Diagnosing chronic exertional compartment syndrome (CECS) is still a challenge. An increase in intramuscular pressure during and following exercise is accepted as the diagnostic standard. However, neither the methods used nor the interpretation of the obtained results are sufficiently standardized. Methods In the present pilot study, the metabolic state of CECS patients was investigated using microdialysis. We hypothesized that there was no difference in intramuscular concentrations of glucose, lactate, glutamate, and glycerol before and after exercise (H10) or between patients suffering from CECS and healthy control subjects (H20). This study was designed as an explorative case-control study (level of evidence III). Twelve patients suffering from CECS of the lower leg and six matched asymptomatic control subjects underwent microdialysis in the anterior (n = 7) or deep posterior compartment (n = 11) of the leg. Following ultrasound-guided insertion of the microdialysis catheters, 10-minute fractions of the dialysates were collected first during rest and then following fatigue- or pain-induced discontinuation of exercise. Dialysates were analysed for lactate, glucose, glutamate, and glycerol concentrations 6 × 10 min before and 6 × 10 min after exercise. Results Exercise-induced increases in lactate, glutamate, and glycerol concentrations were detected in both CECS patients and control subjects (all p < 0.001). No differences between CECS patients and control subjects were found by comparing the intramuscular glucose, lactate, glutamate, and glycerol concentrations at rest and following exercise (all p > 0.05). Conclusions We found exercise-induced increases in the lactate, glutamate, and glycerol levels in skeletal muscle. However, the metabolic changes did not differentiate CECS patients from healthy subjects. Trial registration The registration trial number is DRKS00021589 on DRKS. ‘Retrospectively registered’. Date of registration: April 4, 2020.

scholarly journals Microdialysis for Chronic Exertional Compartment Syndrome

2020 ◽  
Author(s):  
Heinz Lohrer ◽  
Jochen Klein ◽  
Tanja Nauck ◽  
Tobias Schönberg
Keyword(s):  
Compartment Syndrome ◽  
Level Of Evidence ◽  
Chronic Exertional Compartment Syndrome ◽  
Control Subjects ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
Healthy Control ◽  
Exercise Induced ◽  
And Control ◽  
Control Study

Abstract Background: Diagnosing chronic exertional compartment syndrome (CECS) is still a challenge. An increase in intramuscular pressure during and following exercise is accepted as the diagnostic standard. However, neither the methods used nor the interpretation of the obtained results are sufficiently standardized. Methods: In the present study, the metabolic state of CECS patients was investigated using microdialysis. We hypothesized that there was no difference in intramuscular concentrations of glucose, lactate, glutamate, and glycerol before and after exercise (H10) or between patients suffering from CECS and healthy control subjects (H20). This study was designed as an explorative case-control study (level of evidence III). Twelve patients suffering from CECS of the lower leg and six matched asymptomatic control subjects underwent microdialysis in the anterior (n = 7) or deep posterior compartment (n = 11) of the leg. Following ultrasound-guided insertion of the microdialysis catheters, ten-minute fractions of the dialysates were collected first during rest and then following fatigue- or pain-induced discontinuation of exercise. Dialysates were analysed for lactate, glucose, glutamate, and glycerol concentrations 6 × 10 min before and 6 × 10 min after exercise. Results: Exercise-induced increases in lactate, glutamate, and glycerol concentrations were detected in both CECS patients and control subjects (all p < 0.001). No differences between CECS patients and control subjeccts were found by comparing the intramuscular glucose, lactate, glutamate, and glycerol concentrations at rest and following exercise (all p > 0.05). Conclusions: We found exercise-induced increases in the lactate, glutamate, and glycerol levels in skeletal muscle. However, the metabolic changes did not differentiate CECS patients from healthy subjects. Trial registration: The registration trial number is DRKS00021589 on DRKS. 'Retrospectively registered'. Date of registration: April 4, 2020

scholarly journals Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. NP58-NP61 ◽  
Author(s):  
Elizabeth A. Miller ◽  
Anna L. Cobb ◽  
Tyson K. Cobb
Keyword(s):  
Case Report ◽  
Compartment Syndrome ◽  
Single Incision ◽  
Invasive Technique ◽  
Compartment Pressure ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
History Of ◽  
Forearm Pain

Background: Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. Methods: Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. Results: Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. Conclusions: This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

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.

Chronic exertional compartment syndrome: diagnosis, investigation, management and return to training

2018 ◽  
Vol 104 (2) ◽  
pp. 124-128
Author(s):  
R L Thomas ◽  
R Hemingway ◽  
A Keenan ◽  
A Wood
Keyword(s):  
Compartment Syndrome ◽  
Lower Limbs ◽  
Leg Pain ◽  
Military Recruit ◽  
Chronic Exertional Compartment Syndrome ◽  
Military Recruits ◽  
Exertional Compartment Syndrome ◽  
Poor Outcomes ◽  
Exercise Induced ◽  
The Military

AbstractExercise-induced leg pain is a frequent presenting complaint in military recruits. This has several causes, including chronic exertional compartment syndrome (CECS). The pathophysiology of CECS is debated, but it involves pressure increases in particular compartments and reduced compliance in the epimyseal fascia. Its morbidity and poor outcomes with conservative management lead to extended rehabilitation times, and ultimately to a loss of recruits from training. It has been described in various compartments of the upper and lower limbs, but is most frequently encountered in the leg. It is a condition often encountered in the military recruit, and within this demographic is less common than other causes of exertional lower leg pain. However, its debilitating nature and complicated investigative pathway can cause difficulties, and have notable occupational consequences. This article aims to review the evidence surrounding its diagnosis, treatment, prognosis and the implications for the military patient.

scholarly journals Lower Leg Chronic Exertional Compartment Syndrome in Patients 50 Years of Age and Older

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711875717 ◽  
Author(s):  
Johan A. de Bruijn ◽  
Aniek P.M. van Zantvoort ◽  
Michiel B. Winkes ◽  
Marike van der Cruijsen-Raaijmakers ◽  
Adwin R. Hoogeveen ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Older Patients ◽  
Lower Leg ◽  
Leg Pain ◽  
Older Individuals ◽  
Younger Patients ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Exercise Induced ◽  
Lower Leg Pain

Background: Lower leg chronic exertional compartment syndrome (CECS) is usually diagnosed in young and athletic individuals. The presence of CECS in older patients has received little attention in the literature, and patient characteristics are unknown. Purpose: To determine the prevalence of CECS in older patients (≥50 years) and to assess whether older patients with CECS differ clinically from younger patients with CECS. Study Design: Cohort study; Level of evidence, 3. Methods: All individuals with exercise-induced lower leg pain who visited a referral center for CECS between January 2001 and December 2013 were eligible for analysis. Patients were included if history, physical examination, and dynamic intracompartmental pressure measurement indicated CECS. Characteristics of patients 50 years of age or older were compared with characteristics of patients younger than 50. Results: A total of 698 patients with CECS were included: 98 patients were aged 50 years or older and 600 patients were younger than 50 years. Older individuals more often reported a history of lower leg events or comorbidities (≥50 years, 45% vs <50 years, 25%; P < .01) and unilateral symptoms (≥50 years, 45% vs <50 years, 22%; P < .01). Most older patients (62%) did not participate in sport or only walked or hiked, whereas the same was true of only 7% of the younger population. Pain (≥50 years, 94%; <50 years, 96%) and tightness (≥50 years, 57%; <50 years, 62%) were the predominant symptoms of CECS in both groups. Type of CECS differed significantly ( P < .01); the anterior muscle compartment was involved more frequently in older patients (≥50 years, 82% vs <50 years, 59%) and deep flexor muscle CECS was more often diagnosed in younger patients (≥50 years, 26% vs <50 years, 53%). Conclusion: In the present population, 1 in 7 patients diagnosed with lower leg CECS was 50 years of age or older. These individuals were less active and had more comorbidities than patients younger than 50 years. Older individuals predominantly have anterior CECS. Clinicians should consider CECS in older individuals with exercise-induced lower leg pain, particularly if it is unilateral.

scholarly journals Chronic Exertional Compartment Syndrome: A Review of Literature

2022 ◽  
Vol 5 (1) ◽  
pp. 01-03
Author(s):  
Phillip J Stokey ◽  
Sreeram Ravi ◽  
Ethan R Sawyer ◽  
Trevor T Bouck ◽  
Nabil A Ebraheim
Keyword(s):  
Compartment Syndrome ◽  
Review Of Literature ◽  
Compartment Pressure ◽  
Time Intervals ◽  
Chronic Exertional Compartment Syndrome ◽  
Level Of Activity ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
Vascular Compromise ◽  
Proper Diagnosis

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartments pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity.

Post-Exertional MRI Is Useful as a Tool for Diagnosis and Treatment Evaluation for Chronic Exertional Compartment Syndrome of Forearms

2019 ◽  
Vol 24 (03) ◽  
pp. 311-316 ◽  
Author(s):  
Akiko Tominaga ◽  
Kozo Shimada ◽  
Ko Temporin ◽  
Ryosuke Noguchi
Keyword(s):  
Compartment Syndrome ◽  
Treatment Evaluation ◽  
Diagnosis And Treatment ◽  
Intensity Change ◽  
Flexor Digitorum Profundus ◽  
Mri Findings ◽  
Chronic Exertional Compartment Syndrome ◽  
High Area ◽  
Exertional Compartment Syndrome ◽  
Before And After

Background: Chronic exertional compartment syndrome (CECS) is a rare condition, which generally occurs in athletes. Few tools are available for diagnosis and treatment evaluation. We examined pre- and post- exertional forearm magnetic resonance imaging (MRI) before and after fasciotomy since 2013. The purpose of this study was to evaluate the efficacy of pre- and post-exertional MRI before and after fasciotomy. Methods: We treated 8 forearms of 5 patients diagnosed with CECS of the forearms since 2013, including 6 forearms of 3 motocross racers, 1 forearm of 1 baseball pitcher, 1 forearm of 1 manual laborer with a history of muscle contusion. We obtained pre- and post-exertional MRI before and after fasciotomy in all cases. Pre-exertional MRI was obtained when the patient was at rest without any symptom. Post-exertional MRI was obtained after the patients repeated “grip and release” using a hand gripper with maximum effort for approximately 10 minutes until symptoms occurred. We compared MRI findings before and after fasciotomy and evaluated the correlation with clinical outcome. Results: Symptoms disappeared completely in all 3 motocross racers after fasciotomy. MRI at rest showed no abnormal high signals in all cases both before and after fasciotomy. On post-exertional MRI, T2 high area presented mainly in flexor digitorum profundus (FDP) and brachioradialis (BR) and disappeared completely after surgery. Symptoms persisted in the pitcher and the laborer after fasciotomy. T2 high area presented mainly in FDP on post-exertional MRI before fasciotomy and remained on post-exertional MRI after fasciotomy in these two patients. These intensity changes correlated strongly with their symptoms. Conclusions: We performed pre- and post-exertional MRI before and after fasciotomy. The intensity change in T2-weighted images on post-exertional MRI correlated strongly with their symptoms. Post-exertional MRI is useful for diagnosis and treatment evaluation in CECS.

scholarly journals Comparison of 2 Fasciotomes for Treatment of Patients With Chronic Exertional Compartment Syndrome of the Anterior Leg

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110513
Author(s):  
Johan A. de Bruijn ◽  
Aniek P.M. van Zantvoort ◽  
Henricus P.H. Hundscheid ◽  
Adwin R. Hoogeveen ◽  
Percy van Eerten ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Compartment Syndrome ◽  
Perioperative Complications ◽  
Controlled Trial ◽  
Level Of Evidence ◽  
Chronic Exertional Compartment Syndrome ◽  
Associated Symptoms ◽  
Exertional Compartment Syndrome

Background: Chronic exertional compartment syndrome (CECS) of the anterior leg compartment (ant-CECS) is frequently treated with a minimally invasive fasciotomy. Several operative techniques and operative devices exist, but none have been compared in a systematic and randomized manner. Purpose: To compare efficacy, safety, and postoperative pain of a novel operative device (FascioMax fasciotome) with a widely accepted device created by Due and Nordstrand (Due fasciotome) during a minimally invasive fasciotomy for ant-CECS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with bilateral isolated ant-CECS between October 2013 and April 2018 underwent a minimally invasive fasciotomy using the FascioMax fasciotome in 1 leg and the Due fasciotome in the contralateral leg in a single operative session. Symptom reduction at 3 to 6 months and >1 year, postoperative pain within the first 2 weeks, peri- and postoperative complications, and ability to regain sports were assessed using diaries, physical examination, and timed questionnaires. Results: Included in the study were 50 patients (66% female; median age, 22 years [range, 18-65 years]). No differences between the devices were found in terms of perioperative complications (both had none), minor postoperative complications including hematoma and superficial wound infection (overall complication rate: FascioMax, 8% vs Due, 6%), or reduction of CECS-associated symptoms at rest and during exercise. At long-term follow-up (>1 year), 82% of the patients were able to regain their desired type of sport, and 67% (33/49) were able to exercise at a level that was comparable with or higher than before their CECS-associated symptoms started. Conclusion: Both the FascioMax and the Due performed similarly in terms of efficacy, safety, and levels of pain within the first 2 weeks postoperatively. Registration: NL4274; Netherlands Trial Register.

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