QUEBEC CITY — Intracompartmental pressure testing is the only way to definitively diagnose chronic compartment syndrome, but the test is useless without first exercising the affected muscle, said Dr. Preston Wiley at the joint annual meeting of the Canadian Academy of Sport Medicine and the Association Québécoise des Médecins du Sport.
“You first have to reproduce the pain in your office and then measure the intracompartmental pressure.” There is no point to measuring pressure at rest before the patient exercises, he advised.
Rather than sending patients out for a half-hour run to reproduce their symptoms, he asks those with anterior and/or lateral compartment pain to perform repeat dorsiflexion/eversion and plantar-flexion exercises while seated. Posterior compartment pain can be reproduced by having the patient hop on the affected foot.
Although both anterior/lateral and superficial posterior intracompartmental pressures can be measured in the office, deep posterior compartment testing should be done under ultrasound guidance to avoid damaging the neurovascular bundle, said Dr. Wiley, a sports medicine physician at the University of Calgary (Alta.).
An immediate postexercise pressure of more than 30 mm Hg is the first positive reading; confirmation is a measurement of more than 15 mm Hg at 2–3 minutes post exercise. Ample local anesthetic is advised, he stressed, because the device's 16-gauge needle needs to be inserted into the richly innervated fascia.
Intracompartmental pressure testing should be undertaken with the understanding that surgery is the only treatment.
“If the test is positive, patients either have to live with it and possibly modify their activity, or have a fasciotomy. There has never been a reported case that resolved without surgery,” he said.
Suspicion of chronic compartment syndrome can be based on a history of lower leg pain, tightness, and burning after activity, with symptoms subsiding at rest.
“It does not ache in the middle of the night,” Dr. Wiley said in an interview. The muscle that normally swells with exercise is restricted by the tight fascia, resulting in pain, and the area of discomfort reported by the patient clearly outlines a compartment, he explained.
“By having the patient point to the affected area, the physician can have an excellent indication of the problem.”
A test of the anterior compartment should follow dorsiflexion exercises. Courtesy Dr. Preston Wiley