Muscle oxygenation in Type 1 diabetic and non-diabetic patients with and without chronic compartment syndrome

Abstract

BackgroundType 1 diabetic patients and non-diabetic patients were referred for evaluation for chronic exertional compartment syndrome (CECS) based on clinical examination and complaints of activity-related leg pain in the region of the tibialis anterior muscle. Previous studies using near-infrared spectroscopy (NIRS) showed greater deoxygenation during exercise for CECS patients versus healthy controls; however, this comparison has not been done for diabetic CECS patients.MethodsWe used NIRS to test for differences in oxygenation kinetics for Type 1 diabetic patients diagnosed with (CECS-diabetics, n = 9) versus diabetic patients without (CON-diabetics, n = 10) leg anterior chronic exertional compartment syndrome. Comparisons were also made between non-diabetic CECS patients (n = 11) and healthy controls (CON, n = 10). The experimental protocol consisted of thigh arterial cuff occlusion (AO, 1-minute duration), and treadmill running to reproduce symptoms. NIRS variables generated were resting StO2%, and oxygen recovery following AO. Also, during and following treadmill running the magnitude of deoxygenation and oxygen recovery, respectively, were determined.ResultsThere was no difference in resting StO2% between CECS-diabetics (78.2±12.6%) vs. CON-diabetics (69.1±20.8%), or between CECS (69.3±16.2) vs. CON (75.9±11.2%). However, oxygen recovery following AO was significantly slower for CECS (1.8±0.8%/sec) vs. CON (3.8±1.7%/sec) (P = 0.002); these data were not different between the diabetic groups. StO2% during exercise was lower (greater deoxygenation) for CECS-diabetics (6.3±8.6%) vs. CON-diabetics (40.4±22.0%), and for CECS (11.3±16.8%) vs. CON (34.1±21.2%) (P<0.05 for both). The rate of oxygen recovery post exercise was faster for CECS-diabetics (3.5±2.6%/sec) vs. CON-diabetics (1.4±0.8%/sec) (P = 0.04), and there was a tendency of difference for CECS (3.1±1.4%/sec) vs. CON (1.9±1.3%/sec) (P = 0.05).ConclusionThe greater deoxygenation during treadmill running for the CECS-diabetics group (vs. CON-diabetics) is in line with previous studies (and with the present study) that compared non-diabetic CECS patients with healthy controls. Our findings could suggest that NIRS may be useful as a diagnostic tool for assessing Type 1 diabetic patients suspected of CECS.

Review of Reliable and Valid Noninvasive Tools for the Diagnosis of Chronic Exertional Compartment Syndrome

“…The 25 included studies were on the following topics: MRI (n = 8), 1 , 16 , 27 , 39 , 46 , 47 , 54 , 56 NIRS (n = 6), 21 , 31 , 38 , 54 , 55 , 66 EMG (n = 4), 7 , 24 , 41 , 65 SPECT (n = 5), 15 , 23 , 32 , 50 , 52 US (n = 2), 5 , 59 MYO (n = 1), 24 and predictive clinical model (n = 1). 57 …”

“…The exact technique of obtaining NIRS values was specified in 5 studies. 21 , 31 , 38 , 55 , 66 A probe was placed on the skin parallel to the tibialis anterior muscle fibers at the middle one-third of the lower leg and connected to a spectroscope that analyzes data input and displays StO 2 %. 40 , 44 , 55 StO 2 values are measured continuously before, during, and after exercise and also postoperatively if fasciotomy is performed.…”

“… 40 , 44 , 55 StO 2 values are measured continuously before, during, and after exercise and also postoperatively if fasciotomy is performed. 21 , 31 , 38 , 55 , 66 …”

“…Devices used were a continuous dual wavelength NIRS spectrometer (Run-Man CWS-2000; NIM) 31 , 66 and an InSpectra tissue spectrometer (Hutchinson Technology Inc). 21 , 38 , 54 , 55 …”

Peripheral tissue perfusion and associated factors in individuals with type 2 diabetes mellitus: cross-sectional study

“…Therefore, understanding whether there is an association between simple routine measures and peripheral tissue perfusion could assist in clinical practice and add information about tissue microcirculation in these individuals. However, before considering the associations, it is necessary to understand whether there is a difference in the tissue perfusion pattern between healthy individuals and individuals with type 2 diabetes (T2DM) without apparent vascular disease since the studies that exist from this perspective have not evaluated type 2 diabetes,10 either they did not assess the musculature most affected by PAD [10,11] or they did not assess the situation at rest [12,13].…”