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Ultrasound Guided Compartment Pressure Test
for Chronic Exertional Compartment Syndrome:
A Standard Reproducible Protocol
Part 1: Ultrasound anatomy of the lower leg
compartments
Part 2: A standard reproducible protocol for
ultrasound guided compartment testing
Marc R. Silberman, M.D.
New Jersey Sports Medicine and Performance Center
Copyright © 2020 Marc R. Silberman. All Rights Reserved.
Abstract Compartment pressure testing for exertional leg pain
remains the gold standard for diagnosing chronic exertional compartment
syndrome. To date nobody has documented an ultrasound guided standard
protocol for ultrasound guided compartment testing. Musculoskeletal
diagnostic ultrasound is a highly valuable, rapid and inexpensive tool in
the armamentarium of the sports medicine physician. From 2008 to 2020,
the principal author performed 235 compartment pressure tests with zero
complications. A referral center for compartment pressure testing, 92.8%
of tests were positive. Ultrasound anatomy of the lowe leg compartments
can easily be mastered with practice. Once mastered by the sports
medicine clinician, patients with chronic exertional compartment
syndrome can be imaged with ultrasound in the office for ultrasound
guided compartment pressure testing, ultrasound evaluation for
compartment swelling with exercise, and treatment with ultrasound guided
botulinum toxin injections. A standard reproducible protocol for
ultrasound guided compartment pressure testing is described herein
yielding zero complications by the author over a period of 20 years.
Keywords Chronic Exertional Compartment Syndrome; Exertional
Leg Pain; Musculoskeletal Ultrasound; Ultrasound Guided; Compartment
Pressure Test
Cite Silberman MR. Ultrasound Guided Compartment Pressure Test
for Chronic Exertional Compartment Syndrome: A Standard Reproducible
Protocol. Journal of Sports Medicine and Performance. Dec 2020; 1-16.
Key Points
1. Only two entry points are used for needle entry to test all four
compartments of the lower leg.
2. The percentage of bilateral positive cases was 75.23%.
3. Ultrasound measurements of compartment size are taken pre and post
exercise treadmill stress test for diagnosis and treatment decision making.
4. Treatment other than fasciotomy is discussed.
Competing Interests The author declares they have no
competing interests.
Acknowledgement The author would like to thank Rebecca
Silberman for assistance with compilation of the data, Susan Acero for
assistance with computation of the data, and Kaitlin Anders, MS, ATC for
assistance with creation of the images and figures.
Peer Reviewed
References
[1] Netter FH. Atlas of human anatomy –5E. Page 510.
[2] Shah JR, Shah BR, Shah AB. Pictorial essay: Ultrasonography in “tennis
leg.” The Indian Journal of Radiology & Imaging. 2010; 20(4):269-273. doi:
10.4103/0971-3026.73542.
[3] Sanjay M. Khaladkar, Sushen Kumar Kondapavuluri, Anubhav Kamal,
Raghav Kalra, and Vigyat Kamal, “Detection of Myofascial Herniation on
Dynamic Sonography and Magnetic Resonance Imaging,” Case Reports in
Radiology, vol. 2016, Article ID 4245189, 5 pages, 2016. doi:10.1155
/2016/4245189.
[4] Stecco, Carla et al. “Mechanics of crural fascia: from anatomy to
constitutive modelling.” Surgical and Radiologic Anatomy 31 (2009): 523-529.
[5] Webborn N, Morrissey D, Sarvananthan K, et al. Acute tear of the fascia
cruris at the attachment to the Achilles tendon: a new diagnosis. Br J Sports
Med 2015; 49:1398-1403.
[6] Silberman MR, Anders K. Crural Fascia Injuries and Thickening on
Musculoskeletal Ultrasound in athletes with calf pain, calf ‘strains ’, exertional
compartment syndrome and botulinum toxin injections. The Journal of Sports
Medicine and Performance. Nov 2017. Semantic Scholar Corpus ID:
51772868.
[7] Gershuni DH, Gosink BB, Hargens AR, Gould RN, Forsythe JR, Mubarak
SJ, Akeson WH. Ultrasound evaluation of the anterior musculofascial
compartment of the leg following exercise. Clin Orthop Relat Res. 1982 Jul;
(167):185-90.
[8] Rajasekaran S, Beavis C, Aly AR, Leswick D. The utility of ultrasound in
detecting anterior compartment thickness changes in chronic exertional
compartment syndrome: a pilot study. Clin J Sport Med. 2013 Jul;23(4):305-
11. Doi: 10.1097/JSM.0b013e3182856046.
[9] D Wassermann, Z Oschman. Role of ultrasound as a non-invasive method
of diagnosis of chronic exertional compartment syndrome. SA orthop. j. vol.10
n.4 Centurion Jan. 2011.
[10] Christensen JT, Eklof B, Wulff K. The chronic compartment syndrome and
response to diuretic treatment. Acta Chir Scand 149: 249-252, 1983.
[11] Lundvall J, Mellander S, Westling H, White T. Fluid transfer between
blood and tissues during exercise. Acta Physiol Scand 85, 258, 1977.
[12] Cruz AI, Laidlaw MS. Invasive compartment pressure testing for chronic
exertional compartment syndrome: A survey of clinical practice among military
orthopedic surgeons. Am J Orthop 2015 Oct;44(10):E384-9.
[13] Turnipseed WD. Popliteal Artery Entrapment Syndrome. J Vasc Surg
2002;35:910-5.
[14] Pedowitz RA. Hargens AR. Mubarak SJ. Gershuni DH. Modified criteria
for the objective diagnosis of chronic compartment syndrome of the leg. Am J
Sports Med. 1990 Jan-Feb;18(1):35-40.
[15] Waterman B, Laughlin M, Kilcoyne K, Cameron KL, Owens BD. Surgical
Treatment of Chronic Exertional Compartment Syndrome of the Leg. The
Journal of Bone & Joint Surgery: April 3, 2013 - Volume 95 - Issue 7 - p 592-
596.
Article Preview in PDF
Ultrasound Guided Compartment Syndrome Pressure Test
for Chronic Exertional Compartment Syndrome: A
Standard Reproducible Protocol Article Preview
Abstract Copy in PDF
Ultrasound Guided Compartment Syndrome Pressure Test
for Chronic Exertional Compartment Syndrome: A
Standard Reproducible Protocol Abstract
Article Copy in PDF please contact us at 908-467-6464
for Chronic Exertional Compartment Syndrome:
A Standard Reproducible Protocol
Part 1: Ultrasound anatomy of the lower leg
compartments
Part 2: A standard reproducible protocol for
ultrasound guided compartment testing
Marc R. Silberman, M.D.
New Jersey Sports Medicine and Performance Center
Copyright © 2020 Marc R. Silberman. All Rights Reserved.
Abstract Compartment pressure testing for exertional leg pain
remains the gold standard for diagnosing chronic exertional compartment
syndrome. To date nobody has documented an ultrasound guided standard
protocol for ultrasound guided compartment testing. Musculoskeletal
diagnostic ultrasound is a highly valuable, rapid and inexpensive tool in
the armamentarium of the sports medicine physician. From 2008 to 2020,
the principal author performed 235 compartment pressure tests with zero
complications. A referral center for compartment pressure testing, 92.8%
of tests were positive. Ultrasound anatomy of the lowe leg compartments
can easily be mastered with practice. Once mastered by the sports
medicine clinician, patients with chronic exertional compartment
syndrome can be imaged with ultrasound in the office for ultrasound
guided compartment pressure testing, ultrasound evaluation for
compartment swelling with exercise, and treatment with ultrasound guided
botulinum toxin injections. A standard reproducible protocol for
ultrasound guided compartment pressure testing is described herein
yielding zero complications by the author over a period of 20 years.
Keywords Chronic Exertional Compartment Syndrome; Exertional
Leg Pain; Musculoskeletal Ultrasound; Ultrasound Guided; Compartment
Pressure Test
Cite Silberman MR. Ultrasound Guided Compartment Pressure Test
for Chronic Exertional Compartment Syndrome: A Standard Reproducible
Protocol. Journal of Sports Medicine and Performance. Dec 2020; 1-16.
Key Points
1. Only two entry points are used for needle entry to test all four
compartments of the lower leg.
2. The percentage of bilateral positive cases was 75.23%.
3. Ultrasound measurements of compartment size are taken pre and post
exercise treadmill stress test for diagnosis and treatment decision making.
4. Treatment other than fasciotomy is discussed.
Competing Interests The author declares they have no
competing interests.
Acknowledgement The author would like to thank Rebecca
Silberman for assistance with compilation of the data, Susan Acero for
assistance with computation of the data, and Kaitlin Anders, MS, ATC for
assistance with creation of the images and figures.
Peer Reviewed
References
[1] Netter FH. Atlas of human anatomy –5E. Page 510.
[2] Shah JR, Shah BR, Shah AB. Pictorial essay: Ultrasonography in “tennis
leg.” The Indian Journal of Radiology & Imaging. 2010; 20(4):269-273. doi:
10.4103/0971-3026.73542.
[3] Sanjay M. Khaladkar, Sushen Kumar Kondapavuluri, Anubhav Kamal,
Raghav Kalra, and Vigyat Kamal, “Detection of Myofascial Herniation on
Dynamic Sonography and Magnetic Resonance Imaging,” Case Reports in
Radiology, vol. 2016, Article ID 4245189, 5 pages, 2016. doi:10.1155
/2016/4245189.
[4] Stecco, Carla et al. “Mechanics of crural fascia: from anatomy to
constitutive modelling.” Surgical and Radiologic Anatomy 31 (2009): 523-529.
[5] Webborn N, Morrissey D, Sarvananthan K, et al. Acute tear of the fascia
cruris at the attachment to the Achilles tendon: a new diagnosis. Br J Sports
Med 2015; 49:1398-1403.
[6] Silberman MR, Anders K. Crural Fascia Injuries and Thickening on
Musculoskeletal Ultrasound in athletes with calf pain, calf ‘strains ’, exertional
compartment syndrome and botulinum toxin injections. The Journal of Sports
Medicine and Performance. Nov 2017. Semantic Scholar Corpus ID:
51772868.
[7] Gershuni DH, Gosink BB, Hargens AR, Gould RN, Forsythe JR, Mubarak
SJ, Akeson WH. Ultrasound evaluation of the anterior musculofascial
compartment of the leg following exercise. Clin Orthop Relat Res. 1982 Jul;
(167):185-90.
[8] Rajasekaran S, Beavis C, Aly AR, Leswick D. The utility of ultrasound in
detecting anterior compartment thickness changes in chronic exertional
compartment syndrome: a pilot study. Clin J Sport Med. 2013 Jul;23(4):305-
11. Doi: 10.1097/JSM.0b013e3182856046.
[9] D Wassermann, Z Oschman. Role of ultrasound as a non-invasive method
of diagnosis of chronic exertional compartment syndrome. SA orthop. j. vol.10
n.4 Centurion Jan. 2011.
[10] Christensen JT, Eklof B, Wulff K. The chronic compartment syndrome and
response to diuretic treatment. Acta Chir Scand 149: 249-252, 1983.
[11] Lundvall J, Mellander S, Westling H, White T. Fluid transfer between
blood and tissues during exercise. Acta Physiol Scand 85, 258, 1977.
[12] Cruz AI, Laidlaw MS. Invasive compartment pressure testing for chronic
exertional compartment syndrome: A survey of clinical practice among military
orthopedic surgeons. Am J Orthop 2015 Oct;44(10):E384-9.
[13] Turnipseed WD. Popliteal Artery Entrapment Syndrome. J Vasc Surg
2002;35:910-5.
[14] Pedowitz RA. Hargens AR. Mubarak SJ. Gershuni DH. Modified criteria
for the objective diagnosis of chronic compartment syndrome of the leg. Am J
Sports Med. 1990 Jan-Feb;18(1):35-40.
[15] Waterman B, Laughlin M, Kilcoyne K, Cameron KL, Owens BD. Surgical
Treatment of Chronic Exertional Compartment Syndrome of the Leg. The
Journal of Bone & Joint Surgery: April 3, 2013 - Volume 95 - Issue 7 - p 592-
596.
Article Preview in PDF
Ultrasound Guided Compartment Syndrome Pressure Test
for Chronic Exertional Compartment Syndrome: A
Standard Reproducible Protocol Article Preview
Abstract Copy in PDF
Ultrasound Guided Compartment Syndrome Pressure Test
for Chronic Exertional Compartment Syndrome: A
Standard Reproducible Protocol Abstract
Article Copy in PDF please contact us at 908-467-6464
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Copyright 2004 - 2021, New Jersey Sports Medicine and Performance Center LLC.
NJ Sports Medicine LLC. Terms of Use.