Chronic Lower Leg Pain in Athletes

Brewer, Rachel Biber; Gregory, Andrew

doi:10.1177/1941738111426115

Cited by 57 publications

(18 citation statements)

References 65 publications

(104 reference statements)

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“…The diagnosis of CECS is traditionally made by a tripod of procedures: 1) clinical picture; 2) exclusion of differential diagnoses; and 3) needle manometry. 9 18 19 The initial imaging investigation of exercise-related leg pain should be performed with plain x-rays, although in most cases the result of the examination is normal. Magnetic resonance imaging (MRI) of the leg following the conventional protocol, that is, without sequences after the exercise, is a consensus in the literature as the best method to exclude differential diagnoses.…”

Section: Diagnosismentioning

confidence: 99%

O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

Nico

Carneiro

Zorzenoni

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoA síndrome compartimental crônica é uma condição comum e frequentemente subdiagnosticada, induzida pelo exercício, que corresponde em média a um quarto dos casos de dor crônica na perna relacionada ao exercício, e que perde em frequência apenas para o espectro fratura/reação ao estresse tibial. Tradicionalmente ocorre em jovens atletas corredores, embora estudos mais recentes tenham demonstrado uma prevalência considerável em praticantes de atividade física de baixo rendimento, mesmo em pacientes de meia-idade ou idosos. A lista de diagnósticos diferenciais é extensa, e por vezes é difícil fazer a distinção apenas pelos dados clínicos, sendo necessários exames subsidiários.Classicamente, o diagnóstico é feito pelo quadro clínico, pela exclusão dos diferenciais, e pela medida pressórica intracompartimental. Embora a manometria por agulha seja considerada o padrão-ouro no diagnóstico, seu uso não é universalmente aceito, visto que existem algumas limitações importantes, além da disponibilidade restrita do equipamento com agulha no Brasil. Recentemente, novos protocolos de manometria têm sido propostos a fim suplantar a deficiência dos tradicionais, com algum deles inclusive recomendando o uso sistemático da ressonância magnética (RM) na exclusão dos diagnósticos diferenciais. O uso de sequências de RM sensíveis a líquido pós-esforço é uma ótima opção não invasiva à manometria por agulha no diagnóstico da síndrome compartimental crônica, uma vez que o aumento da intensidade de sinal pós-exercício é estatisticamente relevante quando comparados os valores pressóricos de manometria em pacientes com a síndrome e assintomáticos; portanto, o exame pode ser usado no critério diagnóstico. O tratamento definitivo é a fasciotomia, embora existam alternativas menos eficazes.

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Section: Diagnosismentioning

confidence: 99%

O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

Nico

Carneiro

Zorzenoni

et al. 2020

Rev Bras Ortop (Sao Paulo)

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“…Intracompartmental manometry of the 4 compartments of the lower leg is currently the gold standard for diagnosis. 2,3 CECS often occurs simultaneously in both legs, and limited literature exists on the efficacy of simultaneous bilateral fasciotomies versus staged unilateral procedures. A retrospective case series comparing outcomes of bilateral versus staged fasciotomy reported a return to function an average of 12 weeks earlier for patients who underwent bilateral fasciotomy versus a staged single-leg fasciotomy, with adequate patientreported outcomes in both cohorts.…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes Following Fasciotomy for Chronic Exertional Compartment Syndrome

Maher

Brook

Chiodo

et al. 2018

Foot & Ankle Specialist

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“…Leg pain in athletes is a very common condition. This may be due to medial tibial stress syndrome, chronic exertional compartment syndrome, nerve entrapment, popliteal artery entrapment, deep vein thrombosis, and stress fracture [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report

2018

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BackgroundLeg pain in athletes is a common condition and is often related to tibial stress fracture. When non-operative treatment fails, the optimal surgical treatment is controversial. The aim of this study was to report a case of tension band plating of an anterior tibial stress fracture nonunion, treated previously with intramedullary nailing. To the best of our knowledge, this is the first reported case in which tension band plating was placed without removing the preexisting intramedullary nail.Case presentationThe tibial shaft is a common location of stress fracture in athletes. Anterior tibial stress fractures are difficult to manage. When conservative treatment fails, intramedullary nailing is the mainstay of treatment. However, nonunion is a serious complication. In our case, a non-united anterior tibial stress fracture, treated with intramedullary nailing, was addressed with the application of a compression prebended plate over the nail in a 23-year-old French man of African origin who is an elite football player. At 3-months postoperatively he was pain free and started light exercises. At 6-months postoperatively, complete radiologic union of the fracture was evident. He was symptom free; he resumed at that time a full training program and he returned to play football at preinjury high competition level.ConclusionsCompression plating is a valuable method of treating non-united anterior tibial stress fractures. We believe that anterior tension band plating is superior to intramedullary nailing in managing anterior tibial stress fractures, not only after failure of intramedullary nailing, but also as a first-line surgical treatment. This technique offers advantages, such as no violation of the extensor mechanism and risk of anterior knee pain, and directly addresses the underlying problem of distraction forces acting on the anterior tibial cortex and compromising fracture healing. Especially in high-level athletes, who cannot tolerate prolonged inactivity, early surgical intervention of anterior tibial stress fractures with tension band plating is a reliable option that can accelerate recovery.

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Chronic Lower Leg Pain in Athletes

Cited by 57 publications

References 65 publications

O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

Patient-Reported Outcomes Following Fasciotomy for Chronic Exertional Compartment Syndrome

Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report

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