SLR - May 2015 - Katie Hoang

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. Am J Sports Med. 2015 Feb;43(2):392-8.

Scientific Literature Review

Reviewed By: Katie Hoang, DPM
Residency Program: North Colorado Medical Center

Podiatric Relevance: In podiatric medicine, patients may often present for non-specific leg pain. Diagnosing chronic exertional compartment syndrome can be challenging, however this article evaluates how practitioners may diagnose chronic exertional compartment syndrome more readily.
 
Methods: The study included 20 consecutive men with isolated anterior chronic exertional compartment syndrome symptoms, where other diagnoses were excluded utilizing MRI. There were 20 asymptomatic control subjects ranging from 18-40 years old. Patients were evaluated utilizing dynamic compartment pressure testing. A Millar-Cath catheter was placed accordingly into the tibialis anterior muscle. Patients then went through a standardized exercise protocol wearing identical military issued running shoes and intramuscular compartment pressures were recorded. Exercises consisted of resting supine, standing in relaxed resting state for 30 seconds, exercise on treadmill with 15kg backpack at 6.5km/h for five minutes at 0 degrees and 5 degrees, backpack removed incline at 5 degrees at 9.5km/h for 5 minutes, and finally resting supine for five minutes after exercise recovery. Patients were asked pain scale every minute. Anthropometric assessments were performed measuring height, leg length, calf girth, and body mass.

Results: Those with suspected chronic compartment syndrome had higher IMCP immediately after standing at rest compared to controls, 35.5 mmHg vs 23.8 mmHg. Suspected chronic compartment syndrome continually had higher pressures throughout the exercise protocol, especially at period of maximal tolerable pain, 114mmHg vs 68.7mmHg.

Conclusions: This study showed a higher physical demand is mirrored in higher intramuscular compartment pressure (IMCP), with phase two demonstrating the best diagnostic criteria. The authors recommend a diagnostic cutoff value of 105mmHg with dynamic IMCP with a positive likelihood ratio of 12.5.

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