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OBJECTIVE: To investigate current practice in the diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg among orthopedic surgeons in the United Kingdom.
DESIGN: Questionnaire survey. SETTING: Secondary care (NHS and private). PARTICIPANTS: Two hundred six orthopedic surgeons affiliated with one of the following specialist associations: British Association of Sports and Exercise Medicine (BASEM), United Kingdom Association of Doctors in Sport (UKADIS), British Orthopedic Sports and Trauma Association (BOSTA) and British Orthopedic Foot Surgery Society (BOFSS).
INTERVENTIONS: Self-administered questionnaire. MAIN
OUTCOME MEASURES: Current practice in diagnosis and treatment of CECS.
RESULTS: Sixty percent (124/206) of the surveyed population replied and 53% (66/124) see patients with CECS. To confirm the diagnosis, 83% (55/66) use intra-compartmental pressure measurements (ICPs). Of these, 42% use maximal ICP during exercise greater than 35 mmHg as a criterion for anterior CECS diagnosis and 35% use Pedowitz's modified criteria. Of all the respondents, 88% would be willing to adopt a National Framework document for diagnosis, 30% (20/66) always try conservative treatment following diagnosis, 93% (57/60) perform superficial fasciotomy as the first line surgical procedure, 55% (33/60) use a one incision technique for anterior fasciotomy and 60% (36/60) undertake a repeat fasciotomy following failed decompression.
CONCLUSIONS: There is agreement among orthopedic surgeons on the role of ICPs for diagnosis and the choice of fasciotomy as a first-line surgical procedure. In contrast, there is a divergence of opinions regarding the ICP diagnostic thresholds, the role of conservative management and the surgical techniques for fasciotomy and failure of decompression.
I have been doing a little reading on Chronic exertional compartment syndrome and i have been curious on the use to non surgical means of treatment of the leg. The article above and a few others on the topic state the ineffectiveness of modalities such as deep massage, NSAID's, orthotics and stretching, though some did state that massage did elongate the time before the onset of pain.
So i am just wondering what non surgical treatment options are available? I have been unable to locate any articles which describe these in detail on medline and embase but has anyone else come across any? maybe NewsBot can help??
I know that this will depend on which compartment is involved and the aeitiology of the condition.
Has anyone had a large amount of success with non surgical means?
Also regarding surgery, fasciotomy is the treatment of choice it seems, how invasive are these procedures? i Believe that anterior and lateral compartments are less invasive than the deep posterior compartment. What is the length of the incision involved using the one incision or the two incision technique? I have read that they are using less invasive procedures though how less invasive are these?
I too have been reading on compartment syndrome-with more interest on the anterior area being affected chronically
I'm also dissapointed that most of the conservative modalities for treating the problem i.e. massage technique, ice packs, NSAID's etc. not being effective enough
I'm also dissapointed that most of the conservative modalities for treating the problem i.e. massage technique, ice packs, NSAID's etc. not being effective enough
And I always think of surgery as the last resort
Intracompartmental pressure testing and the surgical option need to be high on list.
I myself suffer from anterior compartment syndrome ad it is about as annoying as it comes. I was diagnosed with a rediculously high reading as i was concerned. From age 18 i suffered whilst road running for football training. After 12 mins my foot would burn and my anterior calf would ache and then my foot would go lame and prevent any dorsi or plantar flexion. Funnily enough it occurs exactly 12 minuites into any running, moreso affected in the summer during increased exercise regime by pre-season and unforgiving ground. Control shoes for my mild pronation never helped but combined with functional orthoses completely solved the problem until i dislocated my right knee, now the compartment syndrome is back but switched to the left leg, I felt my orthoses helped tremendously and is always an easier option than surgery to start with. Funnily enough I can run all day in my nike mercurial football boots with no trouble at all, even running home in my boots on the pavement...........
Chronic Exertional Compartment Syndrome
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