1. Dr Leesa Huguenin MP Sports Physicians www.mpsportsphysicians.com.au
Recurrent exertional compartment syndrome – Intracompartmental Pressure Testing
Dr Leesa Huguenin
MP Sports Physicians

2. RECS 95 % lower leg 45% anterior compartment
Lateral, deep posterior and superficial posterior
follow
85- 95% are bilateral
Also possible;
Forearm (kayak, motorcross, sailboard)
thigh, hands and rarely feet

3. Risk factors Increased muscle swelling –
genetic/ overuse/ biomechanical control
Increased fascial thickness/ toughness (?????)
Reduced muscle capillary density
? Creatine supplementation (transient)

4. Table 3 Diagnostic criteria of intracompartmental pressure measurement Authors Year Diagnostically relevant pressure values French and Price" 1962 Postexercise fall time <30 min in normal subjects, > 100 min in patients Reneman" At six minutes postexercise pressure >15 cm H2O (11 mm Hg) above resting pressure Puranen" 1981 Mean pressure of 50 mm Hg during running. Resting of no value, but did observe slow postexercise fall McDermott3' 1982 Mean pressure of 85 mm Hg during running Mubarak and Hargens5" 1982 Resting pressure >15 mm Hg. Exercise pressure >75 mm Hg. Pressure remains >30 mm Hg for >5 min after exercise Qvarfordt et al" 1983 Pressures raised before, during, and after exercise. Postexercise decline 40 min. Ti 6 minWallensten" 1983 No difference at rest, still raised 10 min postexercise (anterior), returned to normal <10 min (deep posterior) Detmer et al" 1985 At rest, normal pressure < 15 mm Hg Styf and Korner" 1986 Muscle relaxation pressure Styf and Korner Postexercise pressure >35 mm Hg remained raised for >6 min (Also muscle relaxation pressure was raised during exercise. >20 mins to return to normal) Allen and Barnes" 1986 Exercise pressure >50 mm Hg anterior, >40 mm Hg deep posterior No difference in resting pressures Fronek et al" 1987 Resting pressure .10 mm Hg and/or .25 mm Hg 5 min after exercise Rorabeck et al' Pre-exercise pressure > 10 mm Hg and postexercise > 15 mm Hg for > 15 min Styfs Relaxation pressure >35 mm Hg, resting pressure >30 mm Hg, postexercise return to normal >6 min Turnispeed et al" 1989 > 20 mm Hg at rest (postexercise increase and slow decline > 10 min) Pedowitz et alr 1990 Pre-exercise pressure .15 mm Hg, or postexercise pressure .30 mm Hg at imin or .20 mm Hg at 5 min

5. My guidelines Resting pressures (post 1st exercise bout) 15-20mmHg +
1 min post exercise mmHg +
Slow recovery patterns, 5 mins > 20 mmHg
Fast recovery ?? Surgical success

6. COMPARTMENT PRESSURE STUDIES
STEP 1
PATIENT IS SENT OUT TO
EXERCISE TO ONSET OF SYMPTOMS

7. COMPARTMENT PRESSURE STUDIES
STEP 2
PATIENT RESTS ON BED –
ultrasound identification of popliteal
blood vessels
Injection of local anaesthetic down
to periosteum

8. COMPARTMENT PRESSURE STUDIES
STEP 3
Insertion of split catheter
Plastic cannula inside needle remains in
Compartment as needle withdrawn,
Needle split and removed

10. COMPARTMENT PRESSURE STUDIES
STEP 4
Cannula is tested for flow and
Secured in place to avoid
kinking

11. COMPARTMENT PRESSURE STUDIES
STEP 5
PATIENT IS EXERCISED –
SINGLE LEG HEEL RAISES TO FAILURE

12. COMPARTMENT PRESSURE STUDIES
STEP 6
PATIENT LIES SUPINE, ANKLE SUPPORTED AT
90 DEGREES
PRESSURES MEASURED AT 1, 3 AND 5 MINS
EXTRA MEASURES IF SLOW RECOVERY

13. COMPARTMENT PRESSURE STUDIES
STEP 7
ADDITIONAL COMPARTMENTS TESTED
ANTERIOR/ LATERAL/ SUPERFICIAL
POSTERIOR

14. COMPARTMENT PRESSURE STUDIES
STEP 8
COMPRESSION DRESSINGS APPLIED
PATIENT INSTRUCTED RE
ACTIVITY OVER NEXT 48 HOURS
AND DISCHARGED HOME WITH
EMERGENCY CONTACT NUMBERS

15. COMPARTMENT PRESSURE STUDIES
FEET!
ESSENTIALLY SAME PROTOCOL

16. COMPARTMENT PRESSURE STUDIES
COMPRESSION DRESSINGS STILL IMPORTANT

17. COMPARTMENT PRESSURE STUDIES
IT IS USUAL TO BE SORE 48 HOURS
= DOMS
COMPLICATIONS ARE RARE
BRUISE/ LOCAL BLEEDING
ACUTE COMPARTMENT SYNDROME
=SEVERE WORSENING PAIN
=EARLY SURGERY

18. Thanks for your attention