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. 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. Dr. Silberman has been performing botox injections in his practice since 2012. After seeing surgical failures for exertional compartment syndrome and having to retest 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 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 knows exactly where the pressures are the highest based on the compartment test and thus knows where best to inject the botox. Dr. Silberman has successfully treated patients with botox who failed fasciotomies; and to date, no athlete who has undergone botox treatment by Dr. Silberman has had to have surgery. Dr. Silberman has also helped athletes with exertional lower leg pain return to running by working on their running form.
The Process: After consultation, which may include an Ankle Brachial Index (ABI) Stress Test (...Dr. Silberman has diagnosed Popliteal Artery Entrapment Syndrome in someone who failed fasciotomies 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 another day with your Botox medication which must be stored in a refrigerator 2° to 8°C (36º to 46ºF) and brought in to the office on ice, recommended within one hour.
Dr. Silberman performs Botox injections for compartment syndrome 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 for compartment syndrome 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 fully.