The magnitude of intramuscular deoxygenation during exercise is an unreliable measure to diagnose the cause of leg pain

Zhang, Q; Rennerfelt, Kajsa; Styf, Jorma

doi:10.1111/j.1600-0838.2011.01392.x

Cited by 8 publications

(12 citation statements)

References 16 publications

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“…The authors in the previous study discussed the production of hydrogen ions producing acidosis during the contraction to stimulate vasodilation. Taken at face value, our recovery data appear to be in contrast to Mohler et al [ 3 ] and Zhang et al [ 17 ] who both reported slower recovery after exercise in their compartment syndrome patients and van den Brand et al [ 14 ] who found no group differences. Different manners in how recovery is calculated might contribute somewhat to the discrepancies between previous studies and our study.…”

Section: Discussioncontrasting

confidence: 99%

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

et al. 2017

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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.

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Section: Discussioncontrasting

confidence: 99%

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

et al. 2017

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“…Five studies exploring the applicability of NIRS used ICPM as reference standard (Supplementary Table 3 ) 24 27 28 29 30 . Studies (n=2) with the Runman probe (NIM inc., Philadelphia) used dorsi- or plantar flexion against resistance for provocation of symptoms 27 29 , whereas studies (n=3) with the InSpectra Tissue Spectrometer (Hutchinson Technology inc., Hutchinson, Minnesota) used a treadmill 24 28 30 . Position of both probe types was at the middle third portion of the tibialis anterior muscle.…”

Section: Resultsmentioning

confidence: 99%

“…Reports with the Runman probe indicated that reoxygenation of muscles after exercise in patients with CECS required more time compared to other ERLP patients and control participants. [27,29] Both studies concluded that NIRS is a useful noninvasive adjunct tool for evaluation of CECS of the anterior compartment. These findings could not be confirmed in a recent study by Rennerfelt et al [28] with the InSpectra Tissue Spectrometer.…”

Section: Near Infrared Spectroscopy (Nirs N=5)mentioning

confidence: 99%

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Systematic Review of Innovative Diagnostic Tests for Chronic Exertional Compartment Syndrome

et al. 2022

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The diagnosis chronic exertional compartment syndrome is traditionally linked to elevated intracompartmental pressures, although uncertainty regarding this diagnostic instrument is increasing. The aim of current review was to evaluate literature for alternative diagnostic tests. A search in line with PRISMA criteria was conducted. Studies evaluating diagnostic tests for chronic exertional compartment syndrome other than intracompartmental pressure measurements were included. Bias and quality of studies were evaluated using the Oxford Levels of Evidence and the QUADAS-2 instrument. A total of 28 studies met study criteria (MRI n=8, SPECT n=6, NIRS n=4, MRI and NIRS together n=1, miscellaneous modalities n=9). Promising results were reported for MRI (n = 4), NIRS (n = 4) and SPECT (n = 3). These imaging techniques rely on detecting changes of signal intensity in manually selected regions of interest in the muscle compartments of the leg. Yet, diagnostic tools and protocols were diverse. Moreover, five studies explored alternative modalities serving as an adjunct, rather than replacing pressure measurements. Future research is warranted as clinical and methodological heterogeneity were present and high quality validation studies were absent. Further optimization of specific key criteria based on a patient’s history, physical examination and symptom provocation may potentially render intracompartmental pressure measurement redundant.

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“…This result is high but in line with previous studies that have reported comorbidity of 42% 6 and 47%. 7 Undiagnosed and untreated comorbidity is a possible cause of unsatisfactory outcome after fasciotomy. If the patient is only operated on with fasciotomy for CACS, the codiagnoses are left untreated.…”

Section: Discussionmentioning

confidence: 99%

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

Rennerfelt

Zhang

Karlsson

et al. 2018

BMJ Open Sport Exerc Med

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AimWe validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.MethodsThe study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient’s history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).ResultsThe sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test–retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test–retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.ConclusionPPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.

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The magnitude of intramuscular deoxygenation during exercise is an unreliable measure to diagnose the cause of leg pain

Cited by 8 publications

References 16 publications

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

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

Systematic Review of Innovative Diagnostic Tests for Chronic Exertional Compartment Syndrome

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

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