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Dr. Silberman specializes in the diagnosis and treatment of exertional
compartment syndrome.  Compartment testing is the gold standard and
only test for the diagnosis of exertional compartment syndrome.  He has
been performing compartment tests for more than 20 years 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. 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 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 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 ultrasound guidance and the gastrocnemius or other
muscle is injected at the site of compression.

Expensive and cancer causing CT Scan imaging are not only harmful but
are not indicated for exertional compartment syndrome diagnosis or
treatment.  There is not one study validating the use of CT Scan for the
diagnosis and treatment of exertional lower leg compartment syndrome in
the scientific literature.  CT Scans give off ionizing radiation and children
are more radiosensitive than adults, with a
positive association of
radiation dose and development of leukemia and brain cancer.

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,
ultrasound examination of  your compartment size, 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. He teaches other
physicians how to perform testing and injections.  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.  

You may experience some soreness 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.  Individual results vary.

As an adjunct to botox, for those with compartment swelling, Dr.
Silberman has been prescribing low dose diuretics with success, an
overlooked and forgotten treatment of exertional compartment syndrome.
The chronic compartment syndrome and response to diuretic treatment.

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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.