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, Sophia; Zhang, Qiuxia; Brisby, Helena; Rennerfelt, Kajsa

doi:10.1007/s00167-020-06143-w

Cited by 15 publications

(15 citation statements)

References 28 publications

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“…Their use harbors the risk of a false diagnosis. Besides this, recent studies suggest genderrelated pressure differences, 25 compartment-specific pressure differences, 26 and pressure differences between military and civilian patients. 28 These findings raise more doubts regarding the diagnostic reliability of ICP measurement.…”

Section: Discussionmentioning

confidence: 92%

“… 60 Currently, dynamic intracompartmental pressure (ICP) measurements are considered gold standard for diagnosis of CECS; however, the validity of this standard has been questioned. 22 , 25 , 26 , 28 , 33 , 63 ICP is an invasive test that carries risks such as bleeding or infection. 8 , 54 , 63 It is an unpleasant, time-consuming procedure, with patients sometimes undergoing multiple punctures for several compartment readings.…”

mentioning

confidence: 99%

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

Kraats

Winkes

Janzing

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Currently, invasive dynamic intracompartmental pressure (ICP) measurements are considered the gold standard for diagnosis of chronic exertional compartment syndrome (CECS). During recent years, different noninvasive imaging modalities have been presented as a possible replacement for ICP measurement. Purpose: To provide an overview of the current state of evidence and possibilities regarding noninvasive diagnostic methods for CECS. Study Design: Scoping review; Level of evidence, 4. Methods: The PubMed (MEDLINE) and Embase databases were searched using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Full-text articles were included if they reported on noninvasive diagnostic methods for CECS, included ≥5 patients with CECS, and were published between 1994 and 2022. Articles not written in English were excluded. Systematic reviews, letters to the editor, and case reports were not eligible for inclusion. Out of 961 articles identified in the initial search, 25 studies (N = 1257 participants) were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies–Comparative (QUADAS-C) tool for comparative studies and the QUADAS-2 tool for noncomparative studies. Narrative synthesis was used to present results. Results: The level of evidence for the 25 studies ranged from 2 to 4. Four studies were classified as having a low risk of bias, 21 studies were classified as being at risk of bias. The following noninvasive diagnostic tools for CECS were reported: magnetic resonance imaging/diffusion tensor imaging (n = 8), near-infrared spectroscopy (n = 6), electromyography (n = 4), single-photon emission computed tomography (n = 5), ultrasound (n = 2), myotonometry (n=1) and predictive clinical model (n = 1). There was insufficient evidence in the literature to support the use of any of these noninvasive diagnostic tools as a gold standard for CECS. Conclusion: Despite the need to replace the controversial use of ICP for the diagnosis of CECS, our review indicated a lack of validity on all discussed noninvasive diagnostic tools as a replacement.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

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

Kraats

Winkes

Janzing

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…The IMP measurements were made using a microcapillary infusion system (Hemo 4; Siemens) connected to a monitor (SC9000; Siemens) according to a previously published protocol. 14 , 15 An 18-gauge (1.2 × 50–mm) IMP needle with 4 side holes at its tip was connected to a transducer line (150 cm) filled with saline, which was linked to the pressure recording system. In the cases where the IMP was measured in the anterior compartment in both legs, 2 IMP needles were connected to the pressure recording system.…”

Section: Methodsmentioning

confidence: 99%

“… 3 CECS can affect all 4 muscle compartments of the lower leg, but isolated CECS of the anterior compartment is the most common engagement. 2 , 3 , 15 …”

mentioning

confidence: 99%

“…IMP measurements have been considered to be a useful objective measure for evaluation of the surgical outcome. 5 Since there are anatomical differences between the 4 compartments of the lower leg, and the median postexercise IMP values are known to vary between the compartments, 15 the IMP values in the different compartments should be evaluated separately. However, few studies have focused solely on 1 specific compartment when comparing preoperative and postoperative IMP values; moreover, in previous studies of anterior compartment postoperative IMP, the majority of the patients were men.…”

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confidence: 99%

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Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

Lindorsson

Zhang

Brisby

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Chronic exertional compartment syndrome (CECS) causes exercise-induced leg pain. The diagnosis is confirmed by intramuscular pressure (IMP) measurements. Fasciotomy has been demonstrated to be a successful treatment for CECS; however, few studies have examined postoperative IMP and long-term outcomes. Purpose: To evaluate long-term outcomes and postoperative IMP in patients surgically treated for anterior CECS, and to identify possible preoperative or postoperative factors associated with overall satisfaction with treatment at follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive series of 209 patients who underwent fasciotomy of the anterior compartment for CECS between 2009 and 2019 and had at least 1 year of follow-up were approached for inclusion. A total of 144 patients (69%), with a follow-up time of 1 to 11.5 years, were ultimately included. All patients underwent preoperative and postoperative 1-minute postexercise IMP measurements of the anterior compartment and completed a questionnaire covering pain and activity parameters at both time points. The follow-up questionnaire included an additional question on overall satisfaction with treatment, and surgical details were collected from the patient’s medical records. Results: The median IMP was significantly lower at follow-up than at baseline (17 mm Hg [range, 5-91 mm Hg] vs 49 mm Hg [range, 25-130 mm Hg]; P < .001). The overall satisfaction rate was 77%, and 83% reported a decreased pain level. The group of patients who were satisfied with the treatment included more men and had a higher ΔIMP and a lower revision rate ( P < .05). Among the 16 patients (11%) who had undergone revision fasciotomies before follow-up, the satisfaction rate was 56%, and 64% reported a decrease in pain level. Conclusion: Fasciotomy significantly reduced 1-minute postexercise IMP in patients with CECS and resulted in satisfaction and decreased pain in more than three-quarters of the patients at long-term follow-up. The male sex and a significant decrease in IMP were both positively associated with treatment satisfaction. Patients who underwent revision surgery before the follow-up had lower satisfaction rates and less pain reduction than the overall group.

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Chronic exertional compartment syndrome of the forearm diagnosed in a wider spectrum of patients and not seldom with a history of the same diagnosis in the lower legs

Sjöcrona,

Lindorsson,

Rennerfelt

2024

J. exp. orthop.

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PurposeTo identify patient characteristics associated with forearm chronic exertional compartment syndrome (CECS) and to demonstrate the distribution of intramuscular pressure (IMP) values at 1 min postexercise in a cohort of patients with exercise‐induced forearm pain.MethodsA consecutive series of 99 patients seeking orthopaedic consultation for chronic exertional forearm pain underwent IMP measurements between 2010 and 2023. The diagnosis of CECS was confirmed (n = 34) or ruled out (n = 65) based on the patient's history, clinical examination and IMP measurements.ResultsThere were significantly more male patients in the CECS group than in the group of patients where the diagnosis was ruled out. Furthermore, a significantly higher proportion of the CECS patients had been previously treated for CECS of the lower legs. The most common occupation was office worker (21%), followed by craftsperson (18%). The most common main physical activities were strength training (21%) and cycling (15%). The median (range) 1‐min postexercise IMP values for patients with CECS were 34 (23–68) mmHg for the flexor compartment and 32 (25–67) mmHg for the extensor compartment.ConclusionThis study demonstrates a more general population of CECS patients compared to previous studies. Notably, more than a fifth of the CECS patients had previously been treated for CECS in the lower legs. Importantly, considering the 95% confidence interval for IMP values in patients without CECS, the most used IMP cutoff value for diagnosing CECS appears to be too high for the forearm compartments.Level of EvidenceLevel II.

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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

Cited by 15 publications

References 28 publications

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

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

Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome of the forearm diagnosed in a wider spectrum of patients and not seldom with a history of the same diagnosis in the lower legs

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