Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain

Rennerfelt, Kajsa; Zhang, Qiuxia; Karlsson, Jón; Styf, Jorma

doi:10.1136/bmjsem-2017-000262

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…However, there are a few studies evaluating the diagnostic potential of PDs, but without the development of specific computer aided diagnostic tools. Rennerfelt et al used PDs for the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain [ 6 ]. Classification of individual drawings was done by two human observers.…”

Section: Discussionmentioning

confidence: 99%

“…Based on PDs, two observers correctly identified patients with and without chronic anterior compartment syndrome (CACS), which is the most common cause of exercise-induced leg pain. The test–retest showed a high inter-observer agreement of 84% [ 6 ]. Abott et al proved that specific Pain Drawing Scores [using the Simple Body Region (SBR) method and the Pain Sites Score (PSS)] in patients with recurrent or chronic low back pain (RCLBP) predict an increased risk of depression, somatization and distress at 1-year follow-up [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Pain drawings as a diagnostic tool for the differentiation between two pain-associated rare diseases (Ehlers-Danlos-Syndrome, Guillain-Barré-Syndrome)

Wester

Mücke

Bender

et al. 2020

Orphanet J Rare Dis

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Background The diagnosis of rare diseases poses a particular challenge to clinicians. This study analyzes whether patients’ pain drawings (PDs) help in the differentiation of two pain-associated rare diseases, Ehlers-Danlos Syndrome (EDS) and Guillain-Barré Syndrome (GBS). Method The study was designed as a prospective, observational, single-center study. The sample comprised 60 patients with EDS (3 male, 52 female, 5 without gender information; 39.2 ± 11.4 years) and 32 patients with GBS (10 male, 20 female, 2 without gender information; 50.5 ± 13.7 years). Patients marked areas afflicted by pain on a sketch of a human body with anterior, posterior, and lateral views. PDs were electronically scanned and processed. Each PD was classified based on the Ružička similarity to the EDS and the GBS averaged image (pain profile) in a leave-one-out cross validation approach. A receiver operating characteristic (ROC) curve was plotted. Results 60–80% of EDS patients marked the vertebral column with the neck and the tailbone and the knee joints as pain areas, 40–50% the shoulder-region, the elbows and the thumb saddle joint. 60–70% of GBS patients marked the dorsal and plantar side of the feet as pain areas, 40–50% the palmar side of the fingertips, the dorsal side of the left palm and the tailbone. 86% of the EDS patients and 96% of the GBS patients were correctly identified by computing the Ružička similarity. The ROC curve yielded an excellent area under the curve value of 0.95. Conclusion PDs are a useful and economic tool to differentiate between GBS and EDS. Further studies should investigate its usefulness in the diagnosis of other pain-associated rare diseases. This study was registered in the German Clinical Trials Register, No. DRKS00014777 (Deutsches Register klinischer Studien, DRKS), on 01.06.2018.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain drawings as a diagnostic tool for the differentiation between two pain-associated rare diseases (Ehlers-Danlos-Syndrome, Guillain-Barré-Syndrome)

Wester

Mücke

Bender

et al. 2020

Orphanet J Rare Dis

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“…To measure IMP, a micro-capillary infusion system (Hemo 4; Siemens, Erlangen, Germany) and a monitor (SC9000; Siemens, Gothenburg, Sweden) were used [ 9 , 14 , 21 ]. The measurements were started 1 min after exercise, with the patient in supine position and the legs extended.…”

Section: Methodsmentioning

confidence: 99%

Significantly lower intramuscular pressure in the posterior and lateral compartments compared with the anterior compartment suggests alterations of the diagnostic criteria for chronic exertional compartment syndrome in the lower leg

Lindorsson

Zhang

Brisby

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate distributions and identify possible differences in intramuscular pressure (IMP) values at 1 min post-exercise between the four muscle compartments of the lower leg, in patients with exertional leg pain with or without chronic exertional compartment syndrome (CECS). Methods A consecutive series of patients seeking orthopaedic consultation for exertional leg pain underwent IMP measurements between 2009 and 2018. The diagnosis of CECS was confirmed (n = 442) or ruled out (n = 422), based on the patient’s history, clinical examination, and IMP measurements. Results The median (range) 1 min post-exercise IMP values in affected compartments in the patients diagnosed with CECS were 33 (25–53) mmHg (deep posterior), 35 (27–54) mmHg (superficial posterior), 40 (26–106) mmHg (lateral), and 47 (24–120) mmHg (anterior). In patients with no CECS, the median (range) 1 min post-exercise IMP values in the compartments were 12 (2–28) mmHg (deep posterior), 12 (2–27) mmHg (superficial posterior), 14 (2–26) mmHg (lateral), and 18 (4–34) mmHg (anterior). The IMP was significantly lower in the lateral and both posterior compartments than in the anterior compartment in both patients diagnosed with CECS and patients without CECS. Conclusion The study demonstrates significantly lower IMP values in the posterior and lateral compartments compared to the anterior compartments. These findings suggest a lowering of the IMP 1 min post-exercise cut-off value for diagnosing CECS in the lateral and both posterior compartments, which may lead to improved treatment of patients with suspected CECS in the lower leg. Level of evidence Level II.

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“…A recent study indicated that patient pain drawings can be a valuable instrument in diagnosing various causes of ELP. 12 Patients with high muscle pressure in the anterior or lateral compartment occasionally experience awkward foot sensations in the dermatome of the deep peroneal nerve (web space between first and second toes) or the superficial peroneal nerve (dorsum of foot), respectively. 5 Our patients were asked to indicate areas of altered skin sensation of the foot, if present, on a drawing.…”

Section: Discussionmentioning

confidence: 99%

“…5 A recent study indicated that patient pain drawings may offer a potential instrument contributing to identifying the cause of ELP. 12 Therefore, when patients experienced altered foot skin sensation and/or tingling, they were asked to mark this area on a drawing (Figure 1).…”

Section: Pain Drawingsmentioning

confidence: 99%

Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

Zantvoort

Hundscheid

Bruijn

et al. 2019

Orthopaedic Journal of Sports Medicine

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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.

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Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain

Cited by 9 publications

References 20 publications

Pain drawings as a diagnostic tool for the differentiation between two pain-associated rare diseases (Ehlers-Danlos-Syndrome, Guillain-Barré-Syndrome)

Pain drawings as a diagnostic tool for the differentiation between two pain-associated rare diseases (Ehlers-Danlos-Syndrome, Guillain-Barré-Syndrome)

Significantly lower intramuscular pressure in the posterior and lateral compartments compared with the anterior compartment suggests alterations of the diagnostic criteria for chronic exertional compartment syndrome in the lower leg

Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

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