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Dr. Silberman specializes in the diagnosis and treatment of exertional
compartment syndrome.  Compartment testing is the gold standard for
the diagnosis of exertional compartment syndrome.  He has been
performing compartment tests since 2003 and is a referral source for
orthopedic surgeons located throughout the United States. He has
presented cases at national conferences and has been published in peer-
reviewed scientific journals on the topic of exertional leg pain and
compartment syndrome.  He has had an interest in exertional
compartment syndrome since fellowship when he presented research on
the low success of surgical treatment at the Annual AMSSM Sports
Medicine Conference.  Click here for his publication on
Crural Fascia
Injuries and Thickening on Musculoskeletal Ultrasound in athletes with
calf pain, calf ‘strains’, exertional compartment syndrome and
botulinum toxin injections.  He has performed over 500 compartment
tests and currently averages more than one per week.

Botox injections are a novel non-surgical intervention that appears to
have promising results in published case studies for the treatment of
exertional compartment syndrome.  Isner-Horobeti et al. published
study on botox for compartment syndrome for those with anterior or
anterior lateral exertional compartment syndrome demonstrating a
success rate of 94% with a drop in pressures measured at 3 to 9 months
post botox treatment.  This study was a small, non-randomized study
only on anterior/anterior lateral cases.  Dr. Silberman to date has had
similar results.

Botox injections also may be an option for those with functional popliteal
artery entrapment syndrome.  Hislop et al. published a case series on 27
patients with
functional popliteal artery entrapment syndrome treated
with ultrasound guided botox injections.  Dr. Silberman has also treated
athletes with functional popliteal artery entrapment syndrome using
ultrasound guided botox injections.

Botox injections can also be used to treat upper extremity chronic
exertional compartment syndrome of the forearm.  Dr. Silberman has
treated musicians, rowers, and climbers with chronic exertional
compartment syndrome of the forearm.

Dr. Silberman has been performing botox injections in his practice since
2012.  After seeing surgical failures for exertional compartment
syndrome, having to restest patients who underwent surgery, where
extensive scar tissue could be felt during retesting, Dr. Silberman began
investigating botox as another option.  New Jersey Sports Medicine and
Performance Center is the only known center in the United States to
offer Ankle Brachial Index Testing, Compartment Testing, and Botox
injections for exertional leg pain under one roof
.  Dr. Silberman
determines which compartments have the highest pressures based on the
compartment test and using those findings, will target the botox injection
under US guidance directly into those compartments.  For popliteal artery
entrapment the popliteal artery is visualized under US guidance and the
gastrocnemius muscle is injected at the site of compression.

The Process:
After consultation, which may include an Ankle Brachial Index (ABI)
Stress Test (...
Dr. Silberman has diagnosed Popliteal Artery
Entrapment Syndrome in multiple athletes who 'tested positive for
compartment syndrome'...
), a Compartment Test, review of imaging, and
video gait analysis, the amount of Botox that will be used for your
treatment is calculated and a prescription for Botulinum Toxin Type A
(Botox) will be given to you to be filled at a pharmacy.  You will then
return on a subsequent day with your Botox medication, which must be
stored in a refrigerator 2° to 8°C (36º to 46ºF), and on the day of the
procedure brought in to the office on ice within one hour.

Dr. Silberman performs Botox injections for compartment syndrome and
popliteal artery entrapment under ultrasound guidance. The injections do
not cause the same amount of discomfort that the compartment test may
have caused.  A local anesthetic will be used and the needle that is used
for the Botox injection is a smaller gauge than the compartment testing
needle.  Botox injections are not injected on the same day as the
compartment test.  Botox injections for compartment syndrome and
popliteal artery entrapment are not covered by insurance.  The cost of  
botox injections for exertional compartment syndrome affecting the
anterior and deep posterior compartments in bilateral legs is $2000.

What to expect:  You may experience some soreness from the needle
and/or the Botox itself after the procedure that may last one to two
weeks.  You may experience temporary weakness in the muscle as well.  
Within one week, you may already experience a decrease in pain and
symptoms.  Within 2 weeks, you may resume light running.  Within one
month, you may be back to sports training fully.

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Botox for Exertional Compartment Syndrome
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