Get Better. Faster.
Dr. Marc Silberman specializes in compartment testing and the diagnosis
of exertional compartment syndrome.  He has been performing
compartment tests for more than 10 years and is a referral source for
orthopedic surgeons located throughout the Northeast and Mid Atlantic.  
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.

Differential Diagnosis of Exertional Leg Pain
Stress Fracture
Periostitis
Periostalgia ('Shin Splints')
Medial Tibial Stress Syndomre
Exertional Compartment Syndrome
Nerve entrapment
Artery entrapment
Vascular disease
Popliteal Artery Entrapment
Spinal radiculopathy
Anemia

Exertional Compartment Syndrome (ECS):
A clinical condition where an athlete classically experiences reproducible
exercise induced lower leg pain that begins at a consistent time with
activity and is relieved with cessation of exercise.  There may be
numbness, tingling, and weakness.  The presentation can be quite
variable and pain may be present all the time even after cessation of
exercise.

Exact cause is unknown though it is felt to be secondary to excessive
pressure within the compartments of the leg leading to reduced blood
flow.

Diagnosis is made by measuring pressures within the leg before and after
exercise.  Pressures normally rise with exercise normally rise with
exercise but should return to baseline within 5 minutes after cessation of
running.  In ECS, elevated pressures result with exertion and remain
elevated for a prolonged length of time.

Compartment Testing:
Your skin is numbed with lidocaine.  A manometer, as imaged above
measuring the anterior compartment, is inserted four separate times into
your leg to measure the four compartments of your lower limb.  You will
then run until symptoms are brought on, with testing repeated 5 minutes
after stopping.

Treatment consists of modification of activity, addressing training error,
orthotic and footwear evaluation, biomechanical (video gait analysis)
evaluation and training, massage and myofascial release, and core and
extremity strengthening.  Once you develop compartment syndrome
though, it appears the only treatment option until recently has been
surgery with fasciotomy, surgical release of the compartments, which has
a greater than 20% failure rate.

Botox injections for exertional compartment syndrome is a novel,
non-surgical intervention that appears to have some promising results in
published case studies.  Dr. Silberman has successfully treated exertional
compartment syndrome with Botox injections in the office.  After
consultation, 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.  Dr. Silberman performs Botox
injections for compartment syndrome under ultrasound guidance.  Botox
injections for compartment syndrome are not covered by insurance.

Publications:

Silberman, Marc R., Brian J. Shiple, and Steven J. Collina. "Exercise
Induced Leg Pain-Soccer." MSSE 36.5 (2004):S93.

Getzin, Andrew R., and Marc Richard Silberman.  "Iliac Artery Flow
Limitations in Endurance Athletes." CSMR 9.6 (2010):334-337.
Get Better. Faster.
Exertional Compartment Testing
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