Botulinum Toxin A for Chronic Exertional Compartment Syndrome: A Retrospective Study of 16 Upper- and Lower-Limb Cases

Abstract

Objective: To assess initial and mid-term efficacy of botulinum toxin A (BoNT-A) injections in patients with chronic exertional compartment syndrome (CECS) in the lower and upper limbs. Design: Retrospective monocentric study. Setting: A University Hospital Department of Physical Medicine and Rehabilitation. Patients: Sixteen patients with CECS of the lower and upper limbs treated with BoNT-A injections (first-line treatment) were included. Interventions, Main Outcome Measures: We collected data from a follow-up consultation (initial pain reduction [complete, partial, or ineffective] and specific activities triggering CECS) and a subsequent phone questionnaire (mid-term efficacy, pain recurrence, and adverse effects). Results: Sixteen patients were included (median age: 25.5 years), and 68.75% reported initial efficacy (4 partial and 7 complete); 8/16 patients were able to resume the activity that triggered CECS. All the patients with initial partial efficacy had pain recurrence (median time of 2.25 months). Among patients with initial complete efficacy, 57.14% had recurrence (median time of 5 months). Minor adverse effects were observed, but with no functional impact. Conclusion: In 16 individuals with CECS treated with BoNT-A injections, we observed moderate efficacy without major adverse effects, but an initial improvement was often followed by recurrence, especially among those with partial initial efficacy.

A 60-Year-Old Man with a 34-Year History of Chronic Exertional Compartment Syndrome and 3 Previous Surgical Fasciotomies, Successfully Treated with Injection of Botulinum Toxin

“…A PubMed search for "compartment syndrome botulinum toxin," yielded 29 publications, only 5 of which were about chronic exertional compartment syndrome. Two were cohort studies which each had 16 patients [10,11], 5 were case reports of which 4 described leg injections [13][14][15][16], and 1 described a hand injection in a post-fasciotomy patient [28]. Collectively, these 5 papers described a total of 37 patients, of whom 33 had leg symptoms and 4 had hand symptoms.…”

“…Given the exertional nature of his symptoms with now-persistent pain at rest, we surmised that he had progressive recurrent CECS, for which he was interested in non-surgical intervention [10,11,[13][14][15][16]. A total of 150 units of BTX-A in a concentration of 100 units: 1 mL was injected into each leg, in 50-unit aliquots into the medial gastrocnemius, lateral gastrocnemius, and lateral compartment.…”

Nonsurgical Management of Chronic Exertional Compartment Syndrome with Botulinum Toxin-A

“…Patients with initial partial efficacy experienced a recurrence of pain at a median time of 2.25 months, while 57.1% of patients with complete relief of symptoms experienced recurrence of pain at a median time of 5 months [24]. Although there was a recurrence of symptoms in several patients, the authors did note that botulinum toxin showed at least moderate efficacy while patients suffered no major adverse effects [24].…”

“…One retrospective study that assessed the efficacy of botulinum toxin-A on CECS examined the cases of 16 patients (median age: 25.5) [24]. The study reported 68.75% efficacy, with seven patients experiencing complete relief of symptoms, and four patients experiencing partial relief of symptoms [24].…”

“…One retrospective study that assessed the efficacy of botulinum toxin-A on CECS examined the cases of 16 patients (median age: 25.5) [24]. The study reported 68.75% efficacy, with seven patients experiencing complete relief of symptoms, and four patients experiencing partial relief of symptoms [24]. Patients with initial partial efficacy experienced a recurrence of pain at a median time of 2.25 months, while 57.1% of patients with complete relief of symptoms experienced recurrence of pain at a median time of 5 months [24].…”