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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.  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. Isner-Horobeti et
al. published
a study on botox for compartment syndrome for those with
anterior or anterior lateral exertional compartment syndrome in 2013
demonstrating a success rate of 94% with a drop in pressures measured
at 3 to 9 months post botox treatment.  Note this study was a small,
non-randomized study only on anterior/anteriorlateral cases.  Dr.
Silberman to date has similar results.  He has been 100% successful in
those with anterior compartment symptoms alone and 80% successful in
those with deep posterior compartment symptoms along with anterior
compartment symptoms.  Be wary of testimonials and magazine articles
as these do not constitute science.

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 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.

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
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 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.

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Botox for Exertional Compartment Syndrome
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