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Bosnina F, Padhiar N, Miller S, Girotra K, Massoura C, Morrissey D. Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review. J Foot Ankle Res 2023; 16:82. [PMID: 37990284 PMCID: PMC10662794 DOI: 10.1186/s13047-023-00680-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Numerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions. METHODS Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions. RESULTS One hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF, n = 31), popliteal artery entrapment syndrome (PAES, n = 22), superficial peroneal nerve entrapment syndrome (SPNES, n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS, n = 5), myofascial tears (n = 3), and McArdle's syndrome (n = 2). CONCLUSION Initial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation.
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Affiliation(s)
- Fatma Bosnina
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Nat Padhiar
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
- London Sportswise, London, UK.
| | - Stuart Miller
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Krishna Girotra
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Chrysovalanto Massoura
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Dylan Morrissey
- Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust Physiotherapy Department, London, UK
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Vogels S, Ritchie ED, de Vries D, Kleinrensink GJ, Verhofstad MHJ, Hoencamp R. Applicability of devices available for the measurement of intracompartmental pressures: a cadaver study. J Exp Orthop 2022; 9:98. [PMID: 36166161 PMCID: PMC9515326 DOI: 10.1186/s40634-022-00529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The indication for surgical treatment of the chronic exertional compartment syndrome is evaluated by measuring intracompartmental pressures. The validity of these invasive intracompartmental pressure measurements are increasingly questioned in the absence of a standardized test protocol and uniform cut-off values. The aim of the current study was to test compartment pressure monitors and needles for uniformity, thereby supporting the physician’s choice in the selection of appropriate test materials. Methods A compartment syndrome was simulated in embalmed above-knee cadaveric leg specimen. Four different terminal devices (Compass manometer, Stryker device, Meritrans transduce, and arterial line) were tested with 22 different needle types. Legs were pressurized after introduction of the four terminal devices in the anterior compartment, using the same needle type. Pressure was recorded at a 30-second interval for 11 minutes in total. Before and after pressurization, the intravenous bag of saline was weighed. Results The simulation of a compartment syndrome resulted in intracompartmental pressure values exceeding 100 mmHg in 17 of the 22 legs (77%). In the other five legs, a smaller built-up of pressure was seen, although maximum intracompartmental pressure was in between 70 and 100 mmHg. The intraclass correlation coefficient was above 0.700 for all possible needle types. Excellent to good resemblance was seen in 16 out of 22 instrumental setups (73%). The mean volume of saline infusion required in runs that exceeded 100 mmHg (309 ± 116 ml) was significantly lower compared to the legs in which 100 mmHg was not achieved (451 ± 148 ml; p = 0.04). Conclusion The intracompartmental pressure recordings of the four terminal devices were comparable, when tested with a standardized pressurization model in a human cadaver model. None of the included terminal devices or needle types were found to be superior. The results provide evidence for more diverse material selection when logistic choices for intracompartmental pressure measurement devices are warranted. Level of evidence Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00529-0.
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Affiliation(s)
- Sanne Vogels
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands. .,Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Ewan D Ritchie
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands
| | - Djuna de Vries
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands
| | | | - Michiel H J Verhofstad
- Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353, GA, Leiderdorp, The Netherlands.,Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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3
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Vogels S, Ritchie ED, van der Burg BLSB, Scheltinga MRM, Zimmermann WO, Hoencamp R. Clinical Consensus on Diagnosis and Treatment of Patients with Chronic Exertional Compartment Syndrome of the Leg: A Delphi Analysis. Sports Med 2022; 52:3055-3064. [PMID: 35904751 DOI: 10.1007/s40279-022-01729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
Abstract
AIM Defining universally accepted guidelines for the diagnosis and treatment of chronic exertional compartment syndrome (CECS) is hampered by the absence of high-quality scientific research. The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS of the leg in civilian and military patient populations. METHODS An international expert group was queried using the Delphi technique with a traditional three-round electronic consultation. Results of previous rounds were anonymously disclosed in the questionnaire of rounds 2 and 3, if relevant. Consensus was defined as > 70% positive or negative agreement for a question or statement. RESULTS The panel consisted of 27 civilian and military healthcare providers. Consensus was reached on five essential key characteristics of lower leg CECS. The panel achieved partial agreement regarding standardization of the diagnostic protocol, including muscle tissue pressure measurements. Consensus was reached on conservative and surgical treatment regimens. However, the experts did not attain consensus on their approach of postoperative rehabilitation and preferred treatment approach of recurrent or residual disease. A summary of best clinical practice for the diagnosis and management of CECS was formulated by experts working in civilian and military healthcare facilities. CONCLUSION The Delphi panel reached consensus on key criteria for signs and symptoms of CECS and several aspects for conservative and surgical treatment. The panel did not agree on the role of ICP values in the diagnostic process, postoperative rehabilitation guidelines protocol, or the preferred treatment approach for recurrent or residual disease. These aspects serve as a first attempt to initiate simple guidelines for clinical practice.
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Affiliation(s)
- Sanne Vogels
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands. .,Trauma Research Unit, Department of Trauma Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - E D Ritchie
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
| | | | | | - W O Zimmermann
- Department of Sports Medicine, Royal Netherlands Army, Utrecht, The Netherlands.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - R Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands.,Trauma Research Unit, Department of Trauma Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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4
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Thakkar R, Tran S, Gillie M, Anderson J. Chronic Exertional Compartment Syndrome in a Fire Captain. Cureus 2022; 14:e27321. [PMID: 36043013 PMCID: PMC9412078 DOI: 10.7759/cureus.27321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
Chronic exertional compartment syndrome (CECS) is a commonly missed diagnosis. It is caused by an increase in intramuscular pressure which subsequently impedes local tissue perfusion and function. It disproportionately occurs in young females; however, the diagnosis should not be excluded in other demographics. We present a case of CECS in an otherwise healthy 53-year-old male fire captain. He presented with pain upon exertion and neurological deficits in the anterior compartment of his bilateral legs that impacted his occupation and daily functioning. Following fasciotomy, the patient returned to work with complete resolution of pain and neurological deficits. This review seeks to describe the prevalence, etiology, diagnostic criteria, differential diagnosis, and management of CECS of the lower extremities, as described in the literature.
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Vogels S, Ritchie ED, Hundscheid HP, van Someren K, Janssen L, Hoencamp R, Scheltinga MR. Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy. Int J Sports Med 2020; 42:559-565. [PMID: 33176383 DOI: 10.1055/a-1273-7777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.
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Affiliation(s)
- Sanne Vogels
- Surgery Department, Alrijne Hospital, Leiderdorp, the Netherlands.,Surgery Department, Máxima Medical Center, Veldhoven, the Netherlands
| | - Ewan D Ritchie
- Surgery Department, Alrijne Hospital, Leiderdorp, the Netherlands
| | | | - Kim van Someren
- Surgery Department, Máxima Medical Center, Veldhoven, the Netherlands
| | - Loes Janssen
- Surgery Department, Máxima Medical Center, Veldhoven, the Netherlands
| | - Rigo Hoencamp
- Surgery Department, Alrijne Hospital, Leiderdorp, the Netherlands.,Defence Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Trauma Research Unit, Department of Trauma Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marc R Scheltinga
- Surgery Department, Máxima Medical Center, Veldhoven, the Netherlands
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6
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Scheltinga M, van Eerten P. Exercise-induced leg pain syndromes : The need for a multidisciplinary point of view. Unfallchirurg 2020; 123:1-2. [PMID: 31960085 DOI: 10.1007/s00113-019-0690-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Scheltinga
- Department of Surgery Máxima Medical Center, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.
| | - Percy van Eerten
- Department of Surgery Máxima Medical Center, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands
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7
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Scheltinga M, van Eerten P. [Exercise-induced leg pain syndromes-German version : The need for a multidisciplinary point of view]. Unfallchirurg 2019; 122:832-833. [PMID: 31712849 DOI: 10.1007/s00113-019-0689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marc Scheltinga
- Department Chirurgie, Máxima Medical Center, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, Niederlande.
| | - Percy van Eerten
- Department Chirurgie, Máxima Medical Center, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, Niederlande
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8
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Patterson Tichy AM, Bradley C. Unilateral Exertional Compartment Syndrome in a Pediatric Competitive Figure Skater. Cureus 2019; 11:e5611. [PMID: 31700724 PMCID: PMC6822883 DOI: 10.7759/cureus.5611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic exertional compartment syndrome (CECS) occurs when there is an increase in interstitial pressure within a non-compliant fascial compartment during exercise. The hallmark sign of CECS is a consistent onset of symptoms at a specific time, distance or intensity of activity followed by resolution of symptoms when the activity is stopped. Chronic exertional compartment syndrome commonly occurs in the lower legs, is bilateral 85% to 95% of the time and occurs most often in running athletes. The purpose of this case report is to describe the clinical presentation of unilateral chronic exertional compartment syndrome in a pediatric athlete that did not present with the hallmark signs for CECS and additionally participates in a sport where CECS is not common. The subject is a 13 year old female competitive figure skater who presented to physical therapy with right calf pain when figure skating and performing functional tasks. During the initial evaluation the patient had pain at rest as well as with objective testing of the right lower leg. The patient did not progress as expected in physical therapy and therefore the differential diagnosis was re-visited and additional measures were performed. The patient was re-diagnosed with unilateral chronic exertional compartment syndrome. The diagnosis was first clinical and later confirmed by intracompartmental testing. This case report illustrates a patient diagnosed with CECS by intra-compartmental pressure testing that did not present with the standard signs and symptoms; she did not participate in a sport where CECS is typically seen and her symptoms were unilateral. This report represents the importance of consistently including CECS in the differential diagnosis of lower leg pain in athletes regardless of the initial presentation and the sport in which they participate. Additionally, it highlights the importance of a detailed subjective history and the significance of aggravating and alleviating factors in relation to training.
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Abstract
Chronic exertional compartment syndrome (CECS) is an overuse injury characterized by increased intracompartmental pressure during exercise. CECS has been described in the foot, thigh, and trunk, but 95% of cases occur in the lower leg. Interestingly, CECS may also affect the upper extremities and has been best described in the forearms. Unfortunately, due to the rarity of this condition, there is no consensus regarding its diagnosis and treatment. This review seeks to discuss the prevalence, etiology, diagnosis, and treatment of CECS of the forearms, which has been described in the literature.
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Affiliation(s)
- Kunal Sindhu
- a Department of Radiation Oncology , Mount Sinai Hospital, Icahn School of Medicine , New York , NY , USA
| | - Brian Cohen
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| | - Joseph A Gil
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| | - Travis Blood
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| | - Brett D Owens
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
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10
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Lohrer H, Malliaropoulos N, Korakakis V, Padhiar N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. PHYSICIAN SPORTSMED 2019; 47:47-59. [PMID: 30345867 DOI: 10.1080/00913847.2018.1537861] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as 'shin splints'. We aimed to review clinical entities that come under the umbrella term 'Exercise-induced leg pain' (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.
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Affiliation(s)
- Heinz Lohrer
- a European SportsCare Network (ESN) - Zentrum für Sportorthopädie , Wiesbaden-Nordenstadt , Germany
| | | | - Vasileios Korakakis
- c Department of Rehabilitation , Aspetar, Orthopaedic and Sports Medicine Hospital , Doha , Qatar
| | - Nat Padhiar
- d William Harvey Research Institute, Centre for Sports & Exercise Medicine , Queen Mary University of London , London , UK
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11
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Stachura KK, Dąbrowska-Galas M. Factors influencing the occurrence of pain and injury in runners. MEDICAL SCIENCE PULSE 2018. [DOI: 10.5604/01.3001.0012.5752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: With the growth of running popularity, the number of running-related injuries has risen. Longterm training and inadequate training loads are only a few factors causing overload injuries amongst runners. Aim of the study: To determine factors influencing the onset of pain and injury in runners. Material and methods: The study involved 150 runners aged 17-64 years (mean age: 30 ± 10 years) and was conducted via a questionnaire containing questions concerning, for example, training frequency, location of pain, type of trauma, treatment and rehabilitation. Results: 38% (n = 57) of runners often felt pain during training. 41% of them (n = 23) reported pain after running short distances and it was most frequently located in the knee joints (26%, n = 15). 48% (n = 72) experienced a running injury. The largest percentage of these (36%, n = 26) were related to knee injuries. As factors causing injuries, the interviewees mentioned one-sided training plan (24%, n = 17), overtraining (24%, n = 17), and insufficient warm-up (16%, n = 12). The analysis of the results has shown a statistically relevant positive correlation (r = 0.177, p < 0.05) between weekly frequency of training and the number of injuries sustained in the last year. The higher the weekly frequency, the more often injures occur amongst runners. Conclusions: The study shows that the occurrence of pain and injury depends on many factors. A frequent cause of any disturbances within the musculoskeletal system is overloaded soft tissue caused by overtraining. Lower limbs, particularly knee joints, are mostly at risk.
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Affiliation(s)
| | - Magdalena Dąbrowska-Galas
- Department of Kinesitherapy and Special Methods, Department of Physiotherapy, School of Health Science in Katowice, Medical University of Silesia in Katowice, Poland
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Sugimoto D, Brilliant AN, d'Hemecourt DA, d'Hemecourt CA, Morse JM, d'Hemecourt PA. Running mechanics of females with bilateral compartment syndrome. J Phys Ther Sci 2018; 30:1056-1062. [PMID: 30154600 PMCID: PMC6110213 DOI: 10.1589/jpts.30.1056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Primary purpose was to compare running mechanics between healthy runners and
runners with chronic exertional compartment syndrome (CECS) including overstride angles,
ankle dorsiflexion (DF) angles, and foot strike patterns. The secondary purpose was to
analyze the association between the overstride angles and ankle DF angles. [Participants
and Methods] Running images of 7 female runners with bilateral CECS patients were captured
at a time of the medical examination. Their running images were compared with gender, age,
and body mass index matched 31 healthy control runners. [Results] The bilateral CECS
female runners have a propensity of running with significantly greater overstride and
ankle DF angles than the healthy female runners. There were no foot strike differences
between the two cohorts. There were a non-significant, poor relationship between
overstride and ankle DF angles in the healthy female runners while a significant, strong
association was found between overstride and ankle DF angles in the bilateral CECS female
runners. [Conclusion] Compared to healthy female runners, bilateral CECS female runners
demonstrated different running mechanics including greater overstride and ankle DF angles.
The two variables were strongly associated with each other in bilateral CECS female
runners, but not in healthy female runners. This may potentially contribute to the
mechanism of CECS development.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital: 9 Hope Ave, Suite 100, Waltham, MA 02453, USA.,Harvard Medical School, USA
| | - Anna N Brilliant
- The Micheli Center for Sports Injury Prevention, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital: 9 Hope Ave, Suite 100, Waltham, MA 02453, USA
| | - Duncan A d'Hemecourt
- Department of Electrical and Computer Engineering, George Washington University, USA
| | - Charles A d'Hemecourt
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital: 9 Hope Ave, Suite 100, Waltham, MA 02453, USA
| | - Jennifer M Morse
- The Micheli Center for Sports Injury Prevention, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital: 9 Hope Ave, Suite 100, Waltham, MA 02453, USA
| | - Pierre A d'Hemecourt
- The Micheli Center for Sports Injury Prevention, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital: 9 Hope Ave, Suite 100, Waltham, MA 02453, USA.,Harvard Medical School, USA
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13
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Askari E, Sadeghi R, Ayati N. A case of popliteal artery entrapment syndrome: easy to miss in early angiographic phase of bone scan. EUROPEAN JOURNAL OF MEDICAL CASE REPORTS 2018:111-113. [DOI: 10.24911/ejmcr/173-1529346107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Park S, Lee HS, Seo SG. Selective Fasciotomy for Chronic Exertional Compartment Syndrome Detected With Exercise Magnetic Resonance Imaging. Orthopedics 2017; 40:e1099-e1102. [PMID: 28617517 DOI: 10.3928/01477447-20170608-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/24/2017] [Indexed: 02/03/2023]
Abstract
Chronic exertional compartment syndrome that is refractory to conservative management should be treated with surgical fasciotomy. However, owing to the limitations of intracompartmental needle manometry in reaching a definite diagnosis, the appropriate timing for fasciotomy and on which compartment remain unclear. The authors report the case of a 22-year-old male military cadet who reported pain in his left calf when running or walking for long distances. The pain was located at the lateral aspect of the calf, from the mid-calf level to the ankle. At another hospital, nonenhanced magnetic resonance imaging had been performed, which showed no considerable abnormality. The authors used exercise magnetic resonance imaging to diagnose chronic exertional compartment syndrome. They performed selective fasciotomy on the compartment that showed a high signal intensity. As a military cadet, the patient was required to jog for more than an hour per day and perform strenuous muscle exercises. He reported that he did not have calf pain or discomfort during such activities 13 months postoperatively. The authors obtained a follow-up exercise magnetic resonance image. Compared with the preoperative magnetic resonance image, the follow-up exercise magnetic resonance image did not show high signal intensity at the lateral compartment. Exercise magnetic resonance imaging is useful in confirming the diagnosis of chronic exertional compartment syndrome and enables the performance of selective fasciotomy on the affected compartment. [Orthopedics. 2017; 40(6):e1099-e1102.].
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Drexler M, Rutenberg TF, Rozen N, Warschawski Y, Rath E, Chechik O, Rachevsky G, Morag G. Single minimal incision fasciotomy for the treatment of chronic exertional compartment syndrome: outcomes and complications. Arch Orthop Trauma Surg 2017; 137:73-79. [PMID: 27670876 DOI: 10.1007/s00402-016-2569-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Chronic exertional compartment syndrome (CECS) is a common injury in young athletes, causing pain in the involved leg compartment during strenuous exercise. The gold standard treatment is fasciotomy, but most of the reports on its effectiveness include relatively small cohorts and relatively short follow-up periods. This study reports the long-term results of a large cohort of young athletes who underwent single-incision fasciotomy for CECS. MATERIALS AND METHODS This a retrospective case-series study. All patients treated by fasciotomies performed for CECS between 2007 and 2011, in a tertiary medical institution. CECS was diagnosed following history taking and clinical evaluation, and confirmed by compartment pressure measurements. Ninety-five legs that underwent single-incision subcutaneous fasciotomy were included. Data on the numerical analog scale (NAS), Tegner activity score, and quality-of-life (QOL) as measured via the short form-12 (SF-12) were retrieved from all patients preoperatively and at the end of follow-up. RESULTS The average time to diagnosis was 22 months and the mean follow-up was 50.1 months. Sixty-three legs underwent anterior compartment fasciotomy (an additional 30 legs also underwent lateral compartment release), and two legs underwent lateral and peroneal compartment releases. The average change in Tegner score was an improvement of 14.6 points. Similarly, the patients reported a significant improvement in the SF-12 and NAS scores. Satisfaction rates were high (average 75.5 %). The main complications were wound infection (2 patients) and nerve injuries (4 patients). Eight patients had recurrence. CONCLUSION Single-incision fasciotomy leads to long-term improvement in the activity level and QOL of patients with CECS.
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Affiliation(s)
- Michael Drexler
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - T Frenkel Rutenberg
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Rozen
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Warschawski
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Rath
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Chechik
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Rachevsky
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Morag
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Zimmermann WO, Helmhout PH, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. J ROY ARMY MED CORPS 2016; 163:94-103. [DOI: 10.1136/jramc-2016-000635] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/26/2016] [Accepted: 05/29/2016] [Indexed: 01/28/2023]
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Smith AEP, Bhatti IN, Hester T, Ritchie JFS. Loin to groin pain: The importance of a differential diagnosis. Int J Surg Case Rep 2015; 16:122-6. [PMID: 26453939 PMCID: PMC4643462 DOI: 10.1016/j.ijscr.2015.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ureteric colic frequently presents as loin to groin pain and accounts for a significant proportion of emergency urological admissions. However, a number of differential diagnoses should be considered in a systematic approach when assessing patients. PRESENTATION OF CASE We report a case of a 30 year old man admitted with severe unilateral loin to groin pain following lumbar specific weightlifting exercises. After a significant delay due to initial mis-diagnosis he was diagnosed with acute paravertebral lumbar compartment syndrome (PVCS) and managed conservatively. DISCUSSION Exertional PVCS is a rare and potentially life threatening condition arising following lumbar specific exercise that has only been recorded a handful of times previously. Patients typically present with intractable lumbar pain and rhabdomyolysis 6-12h following exercise. Due to initial diagnostic delay our case was managed conservatively with fluid resuscitation and monitoring of renal function. CONCLUSION Assessment of patients with loin pain requires a systematic approach. PVCS is a rare cause of lumbar back and loin pain but one that should be considered, particularly in active young males. Early diagnosis is key to prevent the potential sequalae of untreated rhabdomyolysis. There is currently no consensus on management option for PVCS with only a few cases being reported in the literature. We describe successful management with supportive non operative treatment.
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Affiliation(s)
- Alexander E P Smith
- Maidstone and Tunbridge Wells NHS Foundation Trust, 3rd Floor Seminar Room, The Tunbridge Wells Hospital, Tonbridge Road, Tunbridge Wells, Kent TN24QJ, United Kingdom.
| | - Ibrahim N Bhatti
- Maidstone and Tunbridge Wells NHS Foundation Trust, 3rd Floor Seminar Room, The Tunbridge Wells Hospital, Tonbridge Road, Tunbridge Wells, Kent TN24QJ, United Kingdom
| | - Thomas Hester
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital Fracture Clinic, Westminster Bridge Road, London SE17EH, United Kingdom
| | - James F S Ritchie
- Maidstone and Tunbridge Wells NHS Foundation Trust, 3rd Floor Seminar Room, The Tunbridge Wells Hospital, Tonbridge Road, Tunbridge Wells, Kent TN24QJ, United Kingdom
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Voleti PB, Lebrun DG, Roth CA, Kelly JD. Endoscopic Thermal Fasciotomy for Chronic Exertional Compartment Syndrome. Arthrosc Tech 2015; 4:e525-9. [PMID: 26900549 PMCID: PMC4722179 DOI: 10.1016/j.eats.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 05/20/2015] [Indexed: 02/03/2023] Open
Abstract
Chronic exertional compartment syndrome is an activity-induced condition that occurs when intracompartmental pressures within an osteofascial envelope increase during exercise, leading to reversible ischemic symptoms such as pain, cramping, numbness, or weakness. Nonoperative treatment options for this condition have shown limited success and are often undesirable for the patient given the requirement for activity modification. Traditional surgical treatment options involving open or subcutaneous fasciotomies have more favorable results, but these techniques are associated with significant morbidity. Endoscopically assisted fasciotomy techniques afford the advantages of being minimally invasive, providing excellent visualization, and allowing accelerated rehabilitation. The purpose of this article is to describe a technique for performing endoscopically assisted fasciotomies for chronic exertional compartment syndrome of the lower leg using an entirely endoscopic thermal ablating device. The endoscopic thermal fasciotomy technique is associated with minimal morbidity, ensures excellent hemostasis, and affords an early return to sports.
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Affiliation(s)
- Pramod B. Voleti
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Drake G. Lebrun
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Cameron A. Roth
- Cooper Medical School, Rowan University, Camden, New Jersey, U.S.A
| | - John D. Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.,Address correspondence to John D. Kelly IV, M.D., Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market St, Ste 600, Philadelphia, PA 19104, U.S.A.
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Tjeerdsma J. Outcome of a Specific Compartment Fasciotomy Versus a Complete Compartment Fasciotomy of the Leg in One Patient With Bilateral Anterior Chronic Exertional Compartment Syndrome: A Case Report. J Foot Ankle Surg 2015; 55:1027-34. [PMID: 26253475 DOI: 10.1053/j.jfas.2015.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Indexed: 02/03/2023]
Abstract
Chronic exertional compartment syndrome of the leg is a debilitating lower extremity condition in which increased intracompartmental pressure impedes blood flow to the involved compartments of the distal lower extremity, resulting in ischemia and pain. Owing to the lack of success with conservative management, most surgeons perform complete release fasciotomy as the preferred method of fasciotomy to avoid an unsuccessful release or outcome. Studies have been performed regarding the outcomes of complete compartmental release versus specific compartmental release, but no study has been performed comparing complete fasciotomy and compartment-specific fasciotomy in a single patient. The purpose of the present case report was to compare the efficacy of a complete fasciotomy versus a specific fasciotomy in 1 patient with properly diagnosed bilateral anterior compartment chronic exertional compartment syndrome with an 18-month follow-up period. The Lower Extremity Functional Scale and both subscales of the Foot and Ankle Ability Measure were administered to assess the functional outcomes. Circumferential measurements and range of motion photographs were taken to compare the objective data throughout the recovery process. In general, the range of motion, circumferential measurements, and functional outcome measure scores were better for the specific compartmental fasciotomy leg than for the complete fasciotomy leg during the recovery period. The overall functional outcomes were the same for both surgical approaches, with the specific fasciotomy leg returning to baseline function 13 to 23 days before the complete fasciotomy leg. The outcomes remained unchanged 18 months after surgery.
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20
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Luz J, Johnson AH, Kohler MJ. Point-of-care ultrasonography in the diagnosis and management of superficial peroneal nerve entrapment: case series. Foot Ankle Int 2014; 35:1362-6. [PMID: 25249318 DOI: 10.1177/1071100714548198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jennifer Luz
- Spaulding Rehabilitation Hospital, Harvard Medical School, Department of Physical Medicine & Rehabilitation, Boston, MA, USA
| | - A Holly Johnson
- Massachusetts General Hospital, Harvard Medical School, Department of Orthopedics, Boston, MA, USA
| | - Minna J Kohler
- Massachusetts General Hospital, Harvard Medical School, Division of Rheumatology, Allergy, and Immunology, Yawkey Center for Outpatient Care, Boston, MA, USA
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21
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Isner-Horobeti ME, Dufour SP, Blaes C, Lecocq J. Intramuscular pressure before and after botulinum toxin in chronic exertional compartment syndrome of the leg: a preliminary study. Am J Sports Med 2013; 41:2558-66. [PMID: 23969633 DOI: 10.1177/0363546513499183] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Botulinum toxin A (BoNT-A) is used in the treatment of muscle hypertrophy but has never been used in chronic exertional compartment syndrome (CECS). The objective diagnostic criterion in this condition is an abnormally elevated intramuscular pressure (IMP) in the compartment. In this study, the IMP was measured 1 minute (P1) and 5 minutes (P5) after the exercise was stopped before and after BoNT-A injection. HYPOTHESIS Botulinum toxin A reduces the IMP (P1 and P5) and eliminates the pain associated with CECS. STUDY DESIGN Case series; Level of evidence, 4. METHODS Botulinum toxin A was injected into the muscles of moderately trained patients with an anterior or anterolateral exertional compartment syndrome of the leg. The BoNT-A dose (mean ± SD) ranged from 76 ± 7 to 108 ± 10 U per muscle, depending on which of the 5 muscles in the 2 compartments were injected. The primary end point was IMP (P1, P5). Secondary end points were exertional pain, muscle strength, and safety. Follow-up was conducted up to 9 months. RESULTS A total of 25 anterior compartments and 17 lateral compartments were injected in 16 patients. The time interval (mean ± SD) between the BoNT-A injection and after BoNT-A injection IMP measurement was 4.4 ± 1.6 months (range, 3-9 months). In the anterior compartment, P1 and P5 fell by 63% ± 17% (P < .00001) and 59% ± 24% (P < .0001), respectively; in the lateral compartment, P1 and P5 fell by 68% ± 21% (P < .001) and 63% ± 21% (P < .01), respectively. Exertional pain and muscle strength were monitored, based on the Medical Research Council score. The exertional pain was completely eliminated in 15 patients (94%). In 5 patients (31%), the strength of the injected muscles remained normal. In 11 patients (69%), strength decreased from 4.5 (out of 5) to 3.5 (P < .01), although without functional consequences. In the conditions of this study, BoNT-A showed a good safety profile in patients with CECS. CONCLUSION In this case series, BoNT-A reduced the IMP and eliminated exertional pain in anterior or anterolateral CECS of the leg for up to 9 months after the intervention. The mode of action of BoNT-A is still unclear. A randomized controlled study should be carried out to determine whether BoNT-A can be used as a medical alternative to surgical treatment.
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Affiliation(s)
- Marie-Eve Isner-Horobeti
- Marie-Eve Isner-Horobeti, Institut Universitaire de Réadaptation Clémenceau (IURCndash;Strasbourg, 45 boulevard Clémenceau, F-67000 Strasbourg, France. )
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Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health 2012; 4:485-95. [PMID: 24179587 PMCID: PMC3497945 DOI: 10.1177/1941738112445871] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. EVIDENCE ACQUISITION Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. RESULTS Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. CONCLUSION Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions.
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Affiliation(s)
- Robert A. Gallo
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael Plakke
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew L. Silvis
- Department of Orthopedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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23
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Frank RM, Hearty T, Chiampas GT, Kodros SA. Acute Bilateral Exertional Lateral Leg Compartment Syndrome with Delayed Presentation: A Case Report. JBJS Case Connect 2012; 2:e81. [PMID: 29252377 DOI: 10.2106/jbjs.cc.l.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, 1600 West Harrison Street, Suite 300, Chicago, IL 60612.
| | - Thomas Hearty
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611
| | - George T Chiampas
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, Suite 200, Chicago, IL 60611
| | - Steven A Kodros
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1350, Chicago, IL 60611
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Jacobi B, Bongartz G, Partovi S, Schulte AC, Aschwanden M, Lumsden AB, Davies MG, Loebe M, Noon GP, Karimi S, Lyo JK, Staub D, Huegli RW, Bilecen D. Skeletal muscle BOLD MRI: from underlying physiological concepts to its usefulness in clinical conditions. J Magn Reson Imaging 2012; 35:1253-65. [PMID: 22588992 DOI: 10.1002/jmri.23536] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Blood oxygenation-level dependent (BOLD) MRI has gained particular attention in functional brain imaging studies, where it can be used to localize areas of brain activation with high temporal resolution. To a higher degree than in the brain, skeletal muscles show extensive but transient alterations of blood flow between resting and activation state. Thus, there has been interest in the application of the BOLD effect in studying the physiology of skeletal muscles (healthy and diseased) and its possible application to clinical practice. This review outlines the potential of skeletal muscle BOLD MRI as a diagnostic tool for the evaluation of physiological and pathological alterations in the peripheral limb perfusion, such as in peripheral arterial occlusive disease. Moreover, current knowledge is summarized regarding the complex mechanisms eliciting BOLD effect in skeletal muscle. We describe technical fundaments of the procedure that should be taken into account when performing skeletal muscle BOLD MRI, including the most often applied paradigms to provoke BOLD signal changes and key parameters of the resulting time courses. Possible confounding effects in muscle BOLD imaging studies, like age, muscle fiber type, training state, and drug effects are also reviewed in detail.
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Affiliation(s)
- Bjoern Jacobi
- Department of Radiology, University Hospital Bruderholz, Bruderholz, Basel, Switzerland
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25
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Abstract
We report a case of chronic exertional compartment syndrome (CECS) affecting the volar forearm compartment of an elite rower. CECS of the forearm is a less well recognised entity than lower limb CECS. We describe a typical history and detail a potential treatment.
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Abstract
Peripheral nerve entrapments are a relatively rare and heterogeneous group of nerve disorders encompassing a wide variety of etiologies and clinical presentations. These conditions can present significant diagnostic challenges, owing to both the variety of symptoms these patients display, along with the anatomic variation that exists between individuals. Precise knowledge of the anatomic course, the common motor and sensory distributions of each of the peripheral nerves, and judicious use of imaging or electrodiagnostic testing can greatly assist in arriving at a correct diagnosis. In this article, we discuss in detail the anatomy, clinical presentation, diagnosis, and treatment options for peripheral nerve entrapments of the lower extremity involving the sural, saphenous and common, superficial, and deep peroneal nerves.
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Affiliation(s)
- Ryan M Flanigan
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY 14642, USA
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