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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 averages about one per week.

Botox injections are a novel non-surgical intervention that have
promising results in published case studies for the treatment of exertional
compartment syndrome.  In 2008, Lecocq and Inser-Horobeti were the
first to publish the successful use of botox for the treatment of exertional
compartment syndrome (Lecocq, J., and Isner Horobeti. "Treatment of
exertional compartment syndrome leg with botulinum toxin A: a first
open pilot study." J Rehabil Med 40. Suppl 47 (2008): 111-112.)  In
2013, Isner-Horobeti et al. followed that small pilot study with
another
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.  Childers and Fishman in 2 separate studies
in 2002 treated entrapment of a gluteal artery with botox for the
treatment of piriformis syndrome.  In 2015, Isner-Horobeti published an
article
Botulinum Toxin as a treatment for functional popliteal artery
entrapment syndrome.  Hislop et al. in 2017 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 muscle injections in his
practice since 2012.  After seeing surgical failures for exertional
compartment syndrome and exertional leg pain, 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, or
$500 per compartment.

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 though it may take
several weeks to feel the full effect.

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Get Better. Faster.
Botox for Exertional Compartment Syndrome
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Anterior Compartment
Botox Ultrasound Guided
Injection into Tibialis
Anterior Muscle
Anterior Compartment Botox
Ultrasound Guided Injection
into Extensor Hallucis
Longus Muscle directed at
neurovascular bundle
Lateral Compartment Botox
Ultrasound Guided Injection
into Peroneus Longus Muscle
Ankle Brachial Index Test used
to screen for popliteal artery
entrapment syndrome or iliac
artery endofibrosis or kinking.