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 a 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. His success rate is 100% in those with anterior compartment symptoms alone and 90% successful in those with deep posterior compartment symptoms along with anterior compartment symptoms.
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.