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Ortiz-Miguel S, Miguel-Pérez M, Blasi J, Pérez-Bellmunt A, Ortiz-Sagristà JC, Möller I, Agullo JL, Iglesias P, Martinoli C. Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings. Surg Radiol Anat 2023; 45:1603-1617. [PMID: 37812286 PMCID: PMC10625514 DOI: 10.1007/s00276-023-03242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Compartment syndrome is a surgical emergency that can occur in any part of the body and can cause cell necrosis when maintained over time. The resulting defects can affect the nerves, muscle cells, bone tissue, and other connective tissues inside the compartment, and fasciotomy has to be performed. The anatomical and histological characteristics of the leg make acute, chronic, and exertional compartment syndrome more likely in this limb. For these reasons, knowledge of the ultrasound, anatomical, and histological features of the crural fascia can help in the treatment of leg compartment syndrome. METHODS Twenty-one cryopreserved lower limbs from adult cadavers and from one 29-week-old fetus were obtained from the dissection room. They were examined by ultrasound and a subsequent anatomical dissection and microscopy to study the crural fascia and its relationship with the different muscles. Anthropometric measurements were taken of the distances from the head of the fibula and lateral malleolus to the origin of the tibialis anterior muscle in the crural fascia, the exit of the superficial fibular nerve, and the fascia covering the deep posterior muscles of the leg. RESULTS The crural fascia has very important clinical relationships, which can be identified by ultrasound, as the origin of the tibialis anterior muscle at 16.25 cm from the head of the fibula and the exit of the superficial fibular nerve that crosses this fascia at 21.25 cm from the head of the fibula. Furthermore, the presence of a septum that fixes the deep posterior muscles of the leg and the vessels and nerve can be seen by ultrasound and can explain the possible development of a posterior compartmental syndrome of the leg. Awareness of these features will help to keep these structures safe during the surgical treatment of compartment syndrome. CONCLUSION The ultrasound study allows identification of anatomical structures in the leg and, thus, avoids damage to them during surgery for compartmental syndromes.
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Affiliation(s)
- S Ortiz-Miguel
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, C/Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
- Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), Spain
| | - M Miguel-Pérez
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, C/Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain.
| | - J Blasi
- Unit of Histology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - A Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), Spain
| | | | - I Möller
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, C/Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - J L Agullo
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, C/Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - P Iglesias
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, C/Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
| | - C Martinoli
- Cattedra di Radiologia "R"-DICMI, Universita di Genova, Genoa, Italy
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Tarabishi MM, Almigdad A, Almonaie S, Farr S, Mansfield C. Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature. Cureus 2023; 15:e47797. [PMID: 38022185 PMCID: PMC10676709 DOI: 10.7759/cureus.47797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.
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Affiliation(s)
- Mohammed M Tarabishi
- Department of Reconstructive Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
- Department of Pediatric Orthopedic and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, AUT
| | - Ahmad Almigdad
- Department of Orthopedics, Royal Medical Services, Amman, JOR
| | - Shahd Almonaie
- Department of Orthopedic Surgery, Alfaisal University College of Medicine, Riyadh, SAU
| | - Sebastian Farr
- Department of Pediatric Orthopedics, Orthopaedic Hospital Speising, Vienna, AUT
| | - Clemens Mansfield
- Department of Pediatric Orthopedic and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, AUT
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Egerton T, Donkin D, Kazantzis S, Ware H, Moore S. Conceptualisation of a region-based group of musculoskeletal pain conditions as 'tibial loading pain' and systematic review of effects of load-modifying interventions. J Sci Med Sport 2021; 25:46-52. [PMID: 34366244 DOI: 10.1016/j.jsams.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Conceptualisation of a clinically-relevant group of conditions as a region-based, load-related musculoskeletal pain condition ('tibial loading pain') to enable identification of evidence of treatment effect from load-modifying interventions. DESIGN Systematic review and evidence synthesis based on a developed and justified theoretical position. METHODS Musculoskeletal pain localised to the tibial (shin) region and consistent with clinical presentations of an exercise/activity-related onset mechanism, was conceptualised as a group of conditions ('tibial loading pain') that could be reasoned to respond to load modifying interventions. Five databases were searched for randomized controlled studies investigating any load-modifying intervention for pain in the anterior-anteromedial lower leg (shin). Study quality was evaluated (Risk of Bias Tool Version 2) and level of certainty for the findings assessed. RESULTS Six studies reporting seven comparisons were included. Interventions included braces, anti-pronation taping, compression stocking and a stretch + strengthening programme. All included studies were assessed as having unclear or high risk of bias. The review found no evidence of beneficial effect from any of the load-modifying interventions on symptoms, physical performance or biomechanical measures, apart from a possible benefit of anti-pronation 'kinesio' taping. There was very low certainty evidence that kinesio taping improves pain and pain-free hopping distance after one week. The braces were associated with minor adverse effects and problems with acceptability. CONCLUSIONS None of the treatments investigated by the included studies can be recommended. Conceptualisation of the problem as regional, primarily loading-related pain rather than as multiple distinct pathoanatomically-based conditions, and clearer load-modifying hypotheses for interventions are recommended.
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Affiliation(s)
- Thorlene Egerton
- Physiotherapy Department, The University of Melbourne, Australia; Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Australia
| | - David Donkin
- Physiotherapy Department, The University of Melbourne, Australia; Department of Health Professions, Macquarie University, Australia
| | - Sia Kazantzis
- Physiotherapy Department, The University of Melbourne, Australia
| | - Hannah Ware
- Physiotherapy Department, The University of Melbourne, Australia; The Melbourne Sports Medicine Centre, Australia
| | - Sonya Moore
- Physiotherapy Department, The University of Melbourne, Australia.
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