SLR - July 2015 - Laura Bohman

Intramuscular Compartment Pressure Measurement in Chronic Exertional Compartment Syndrome: New and Improved Diagnostic Criteria

Reference: Roscoe D, Roberts AJ, Hulse D. Intramuscular compartment pressure measurement in chronic exertional compartment syndrome: new and improved diagnostic criteria. Am J Sports Med. 2015 Feb;43(2):392-8.

Scientific Literature Review

Reviewed By: Laura Bohman, DPM
Residency Program: Cambridge Health Alliance

Podiatric Relevance: Chronic exertional compartment syndrome (CECS) is a debilitating pathology that is often not improved with conservative treatment.  Accurate diagnosis of this condition prior to surgical intervention is important to prevent unnecessary surgery and a delay of appropriate treatment.  Previously, as recommended by Pedowitz et al, the diagnosis for CECS was made by taking intramuscular pressure measurements before and after an exercise challenge.  In this article, a new diagnostic criteria is introduced using dynamic intramuscular compartment pressure measurements before, during, and after exercise.

Methods: Twenty men between the ages of 18-40 with a BMI less than 35, no lower limb length discrepancy, and symptoms of CECS were included in this study.  These patients also had a normal lower extremity and lumbar MRI, no prior lower extremity surgeries, and no other lower limb injuries. They were compared to 20 control subjects with similar demographics.  A Millar Mikro-Cath Catheter wire was inserted into the both anterior tibialis muscle bellies of each patient. The catheter was held in place for several measurements that were obtained at an initial period of rest, standing, during three phases of exercise, and after five minutes of rest. The mean pressures taken during these time periods were then analyzed.  

Results: No significant differences were seen at rest between the patient and control population. Statistical significant differences were seen during standing, exercise, and rest between the patient and control populations. However, when carrying a 15kg backpack at a 5% incline at 6.5km/hr during phase two of exercise, a “good” predictive validity and specificity of 95% was found. This was in comparison to a “poor” predictive validity and specificity of 65% when testing the intramuscular pressures after five minutes of rest.

Conclusions: This study finds that a dynamic measurement of intramuscular compartment pressures taken during exercise, and more specifically during phase two of exercise, provide the best diagnostic criteria for CECS. The authors suggest that with this new diagnostic criterion, the appropriate populations of patients are taken to surgery, and that these patients experience better surgical outcomes from fascial release.

Educational Opportunities