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Dyrek P, Kuwabara A, Fredericson M. A Rare Case Report of Exertional Leg Pain. Clin J Sport Med 2024; 34:149-151. [PMID: 37526496 DOI: 10.1097/jsm.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
ABSTRACT The accurate diagnosis of exertional leg pain in athletes is often delayed because of vague presenting symptoms and nonspecific physical examination findings. This case report outlines exertional leg pain in a runner caused by combined popliteal artery entrapment and soleal sling syndromes, 2 uncommon causes of exertional leg pain. This case report highlights the overlapping clinical presentation of these 2 diagnoses and the intricate differences in diagnostic workup and surgical approach to management.
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Affiliation(s)
- Paige Dyrek
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, California
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2
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Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
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Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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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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Lawley RJ, Kasitinon D, Sisk D, Lavingia KS, Lee JT, Fredericson M. Concurrent Diagnosis of Functional Popliteal Artery Entrapment Syndrome and Chronic Exertional Compartment Syndrome in Athletes. Curr Sports Med Rep 2022; 21:366-370. [DOI: 10.1249/jsr.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Castillo-Domínguez A, García-Romero JC, Alvero-Cruz JR, Ponce-García T, Benítez-Porres J, Páez-Moguer J. Systematic Review of Patient-Reported Outcome Measures for Patients with Exercise-Induced Leg Pain. Medicina (B Aires) 2022; 58:medicina58070841. [PMID: 35888560 PMCID: PMC9318164 DOI: 10.3390/medicina58070841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: To determine the most commonly used patient-reported outcome measures (PROMs) in exercise-induced leg pain (EILP) and to identify specific PROMs for EILP in order to evaluate their psychometric properties and methodological quality. Materials and Methods: A strategic search was performed in different databases to identify and extract the characteristics of studies based on the use of PROMs in patients with EILP. Specific PROMs were evaluated according to the Terwee et al. and COSMIN criteria. Results: Fifty-six studies were included in the review. The Medial Tibial Stress Syndrome Score (MTSSS), Lower Extremity Functional Scale (LEFS) and Exercise-Induced Leg Pain Questionnaire (EILP-Q) were identified as specific PROMs for EILP. The Visual Analog Scale (VAS) was the most widely used instrument in the assessment of EILP. The methodological quality assessment showed six positive values for the LEFS, four for the MTSSS and three for the EILP-Q for the eight psychometric properties analyzed according to the COSMIN criteria. The evaluation of the nine psychometric properties according to Terwee showed five positive values for the LEFS and MTSSS, and three for the EILP-Q. Conclusions: The overall methodological quality of the PROMs used was low. The VAS was the most widely used instrument in the assessment of EILP, and the LEFS was the highest quality PROM available for EILP, followed by the MTSSS and EILP-Q, respectively.
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Affiliation(s)
| | - Jerónimo C. García-Romero
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - José Ramón Alvero-Cruz
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Tomás Ponce-García
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Javier Benítez-Porres
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Joaquín Páez-Moguer
- Department of Nursing and Podiatry, University of Malaga, 29071 Malaga, Spain;
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Chronisches Logen‑/Kompartmentsyndrom beim Sportler. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Chronic exertional compartment syndrome (CECS) is characterized by an excessive increase in intracompartmental muscle pressures after exercise. Athletes with CECS report pain, pressure, and occasionally neurologic symptoms in the affected compartment during exercise that abates with rest. Although many treatment options have been proposed, athletes often require a fasciotomy to return to unrestricted sports participation. Surgical success rates vary; complications are not uncommon; and after surgery, it usually takes athletes 6 or more weeks to return to unrestricted impact activities. This case report describes a new ultrasound-guided fasciotomy technique for the treatment of anterior leg compartment CECS. The procedure required a 3 mm incision, was performed in the office under local anesthesia, and allowed the athlete to resume running within 1 week of the procedure. Although the preliminary results of this study are promising, further translational research is required before the widespread adoption of this procedure is recommended.
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Reisner JH, Noble-Taylor KE, Cummings NM, Lachman N, Finnoff JT. Ultrasound-Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation. PM R 2020; 13:862-869. [PMID: 32844578 DOI: 10.1002/pmrj.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic exertional compartment syndrome (CECS) is a type of leg pain related to elevated intracompartmental pressure with activity in one or more of the four compartments of the leg. Open fasciotomy is the definitive treatment for CECS but has a reported complication rate of up to 15.7% and return to full activity reported up to 16 weeks. Ultrasound-guided (USG) fasciotomy of the anterior and lateral compartments has been translated into clinical practice. OBJECTIVE To determine the safety and feasibility of a USG fasciotomy of the deep posterior compartment (DPC) and superficial compartment (SPC) of the leg in a fresh-frozen cadaveric model. DESIGN Prospective, cadaveric laboratory investigation. SETTING Procedural skills laboratory at an academic institution. CADAVERIC COHORT Ten fresh-frozen cadaveric knee-ankle-foot specimens from five female and five male donors aged 58 to 93 years (mean 77.4 years) with body mass indexes of 18.1 to 33.5 kg/m2 (mean 25.1 kg/m2 ). METHODS OR INTERVENTIONS One experienced operator performed 10 USG DPC and SPC fasciotomies. A clinical anatomist performed dissections of each. MAIN OUTCOME MEASURES Achievement of target length and continuity of release was recorded. Target lengths of 10 cm for the superficial posterior compartment (SPC) and 15 cm for the deep posterior compartment (DPC) were established based on previous studies. Tendinous and neurovascular structures were assessed for damage. RESULTS No tendon or neurovascular injuries were observed. In the SPC, target length was achieved in 90% and continuous release was observed in 80%. In the DPC, target length was achieved in 60% and continuity observed in 30%. CONCLUSIONS These findings suggest that SPC USG fasciotomies using the technique described in this study are feasible, may be safe, and warrant further translational research; however, DPC USG fasciotomies are more challenging and require more technical refinement prior to clinical translation.
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Affiliation(s)
- Jacob H Reisner
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kayle E Noble-Taylor
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nancy M Cummings
- Department of Orthopedics and Sports Medicine, Mayo Clinic College of Medicine and Science, Minneapolis, MN, USA
| | - Nirusha Lachman
- Department of Clinical Anatomy and Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jonathan T Finnoff
- United States Olympic and Paralympic Committee, Colorado Springs, CO, USA
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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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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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Drigny J, Reboursière E, Desvergée A, Ruet A, Hulet C. Concurrent Exertional Compartment Syndrome and Functional Popliteal Artery Entrapment Syndrome: A Case Report. PM R 2019; 11:669-672. [PMID: 30689303 DOI: 10.1002/pmrj.12081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/07/2018] [Indexed: 11/11/2022]
Abstract
Exertional leg pain is a common and disabling condition in athletes with challenging diagnosis and management. We report the case of a 29-year-old rugby player with a history and clinical examination consistent with chronic exertional compartment syndrome (CECS). Compartment pressure measurement was supportive of the diagnosis. However, magnetic resonance angiography (MRA) with provocative maneuvers showed functional popliteal artery entrapment syndrome (PAES). For the treatment of CECS, bilateral fasciotomy of the anterolateral compartments permitted return to full sport participation in 8 weeks. A follow-up MR angiogram at 12 months showed resolution of the popliteal entrapment leading us to hypothesize a possible relationship between CECS and functional PAES.
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Affiliation(s)
- Joffrey Drigny
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, Unité Inserm COMETE, UMR U1075, CHU de Caen, Caen, France
| | | | - Antoine Desvergée
- Service de Médecine Physique et de Réadaptation, Service de Médecine du Sport, CHU de Caen, Caen, France
| | - Alexis Ruet
- Service de Médecine Physique et de Réadaptation, CHU de Caen, Caen, France
| | - Christophe Hulet
- Département D'orthopédie-Traumatologie, Unité Inserm COMETE, UMR U1075, CHU de Caen, Caen, France
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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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Gatenby G, Haysom S, Twaddle B, Walsh S. Functional Outcomes After the Surgical Management of Isolated Anterolateral Leg Chronic Exertional Compartment Syndrome. Orthop J Sports Med 2017; 5:2325967117737020. [PMID: 29164162 PMCID: PMC5682587 DOI: 10.1177/2325967117737020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Failure rates of up to 20% have been reported after fasciotomy for chronic exertional compartment syndrome (CECS). There is some evidence that postoperative failure and complication rates are higher in the posterior compartments of the lower leg than the anterolateral compartments. Isolated compartment surgery may put patients at risk of requiring revision surgery because of the risk of developing posterior compartment disease. Hypothesis: Isolated anterolateral fasciotomy for CECS, in the absence of posterior compartment symptoms, produces satisfactory functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Between 2006 and 2012, patients who had positive intracompartment pressure-testing findings and who underwent isolated anterolateral fasciotomy release for CECS were given a self-administered questionnaire. The minimum follow-up was 3 years. The questionnaire addressed time to return to sport and ongoing symptoms. A visual analog scale was used to assess pain during exercise before and after surgery (score: 0, no pain; 10, worst pain imaginable); overall satisfaction with the procedure was assessed as well. Of 31 eligible patients, 20 patients (36 legs operated on) were assessed. Results: Postoperatively, 90% of participants returned to the same or higher level of sport. The mean pain score during exercise before surgery was 8.17, whereas it was 1.74 after surgery. The overall mean patient satisfaction score was 8.64. Only 1 leg (2.8%) went on to develop posterior compartment syndrome. Conclusion: Isolated anterolateral fasciotomy for CECS produced excellent functional outcomes. Our rate of recurrence was low compared with those found in the literature, and 90% of participants returned to their same or higher level of sport postoperatively.
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Abstract
A 33-year-old elite female runner presented to a tertiary care sports medicine clinic with a 2-year history of progressive anterior thigh and circumferential leg pain with associated foot paresthesias brought on by high-intensity running. She had both external iliac artery vasospasm and chronic exertional compartment syndrome. External iliac artery vasospasm is a rare cause of exertional leg pain, particularly in the running population. This case highlights the unique features of this condition, addresses the multidisciplinary approach that led to the accurate diagnoses, and demonstrates that more than 1 etiology for exertional leg pain can coexist in an athlete.
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Affiliation(s)
- Kristin L Garlanger
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Elena J Jelsing
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
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Abstract
Exertional leg pain is a common condition seen in runners and the general population. Given the broad differential diagnosis of this complaint, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and management of common causes that include medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves. Successful diagnosis of these conditions hinges on performing a thorough history and physical examination followed by proper diagnostic testing and appropriate management.
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Affiliation(s)
- Sathish Rajasekaran
- Department of Orthopaedics and Rehabilitation, University of Iowa Sports Medicine, 2701 Prairie Meadow Drive, Iowa City, IA 52242, USA; Division of Physical Medicine and Rehabilitation, University of Alberta, 10230 111 Avenue Northwest, Edmonton, AB T5G 0B7, Canada.
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905, USA; Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Sacramento, CA 95817, USA; Mayo Clinic Sports Medicine Center, Mayo Clinic Square, 600 Hennepin Avenue, Suite 310, Minneapolis, MN 55403, USA
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Ultrasound-Guided, Percutaneous Needle Fascial Fenestration for the Treatment of Chronic Exertional Compartment Syndrome: A Case Report. PM R 2016; 8:286-90. [DOI: 10.1016/j.pmrj.2015.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/20/2015] [Accepted: 08/24/2015] [Indexed: 11/15/2022]
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Lueders DR, Howe BM, Sellon JL. Inflammatory Myopathy Causing Leg Pain in a Soccer Player: Case Report and Return-to-Play Considerations. PM R 2015; 8:380-383. [PMID: 26424108 DOI: 10.1016/j.pmrj.2015.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
Leg pain is a common condition in athletes as well as in the general population, and has a broad differential diagnosis that includes musculoskeletal, vascular, rheumatologic, and neurologic etiologies. Idiopathic inflammatory myopathy (IM) is a relatively uncommon but recognized etiology of leg pain. In this case, we describe an acute presentation of IM in an athlete resulting in leg pain and activity limitation. The available literature suggests that moderate-intensity exercise is safe and beneficial in idiopathic IM, but studies to date have not assessed the effects of high-intensity exercise in IM or provided recommendations for return to competitive contact sport in this population.
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Affiliation(s)
- Daniel R Lueders
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN(∗)
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN(†)
| | - Jacob L Sellon
- Sports Medicine Center/Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, W14 Mayo Building, 200 1st St, SW, Rochester, MN 55905(‡).
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18
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Abstract
Chronic exertional compartment syndrome is diagnosed based on historical and physical exam findings combined with elevated intracompartmental pressures. Direct static testing with a large bore needle device is the most common instrument used for diagnosis. Based on the most recent systematic reviews, there is poor evidence for the traditional diagnostic pressures used in practice with no standardization of the procedure. New research has introduced a standardized approach with dynamic testing of the limb with transducer-tipped catheters. Less invasive methods of testing using radiologic techniques are currently under investigation. A detailed understanding of the anatomy and physiology of the limb is paramount in executing a safe and accurate procedure.
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Affiliation(s)
- David Flick
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859
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19
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Cross-cultural Adaptation and Validation of the Exercise-Induced Leg Pain Questionnaire for English- and Greek-Speaking Individuals. J Orthop Sports Phys Ther 2015; 45:485-96. [PMID: 25927499 DOI: 10.2519/jospt.2015.5428] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Clinical measurement. OBJECTIVES To translate the German version of the Exercise-Induced Leg Pain Questionnaire (EILP-G) to Greek and English and evaluate the psychometric properties of the Greek version. BACKGROUND The EILP-G was developed to evaluate the severity of symptoms and sports ability in individuals with exercise-induced leg pain (EILP). Translation of the questionnaire to other languages will provide a standard outcome measure across populations. METHODS The EILP-G questionnaire was cross-culturally adapted to Greek and English, according to established guidelines. The validity and reliability of the Greek version were assessed in 40 patients with EILP, 40 patients with other lower extremity injuries, 40 track-and-field athletes with no history of EILP, and 40 young adults without pathology. Participants completed the questionnaire at baseline and again after 7 to 10 days. RESULTS The expert committee and the participants considered the questionnaire to have good face and content validity. Concurrent validity as assessed using the Schepsis score was almost perfect (rho = 0.947, P<.001). Dimensionality analysis revealed a 1-factor solution, explaining 83.8% of the total variance. Known group validity was demonstrated by significant differences between patients compared with the asymptomatic groups (P<.001). The Greek version exhibited excellent test-retest reliability (intraclass correlation coefficient = 0.995 for the EILP group) and internal consistency (Cronbach α = .942 for the EILP group). Finally, no ceiling or floor effects were found, as none of the individuals with EILP scored the maximum or minimum possible values on the questionnaire. CONCLUSION The Greek version, adapted from the original EILP-G, is a valid and reliable questionnaire, and its psychometric properties are comparable with the original version.
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20
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Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR. Chronic leg pain in athletes. Am J Sports Med 2015; 43:1538-47. [PMID: 25157051 DOI: 10.1177/0363546514545859] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic leg pain is commonly treated by orthopaedic surgeons who take care of athletes. The sources are varied and include the more commonly encountered medial tibial stress syndrome, chronic exertional compartment syndrome, stress fracture, popliteal artery entrapment syndrome, nerve entrapment, Achilles tightness, deep vein thrombosis, and complex regional pain syndrome. Owing to overlapping physical examination findings, an assortment of imaging and other diagnostic modalities are employed to distinguish among the diagnoses to guide the appropriate management. Although most of these chronic problems are treated nonsurgically, some patients require operative intervention. For each condition listed above, the pathophysiology, diagnosis, management option, and outcomes are discussed in turn.
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Affiliation(s)
- M Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jim S Starman
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eric W Carson
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Robert P Wilder
- Physical Medicine and Rehabilitation Department, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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21
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Bonasia DE, Rosso F, Cottino U, Rossi R. Exercise-induced leg pain. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:73-84. [PMID: 29264244 PMCID: PMC5730650 DOI: 10.1016/j.asmart.2015.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 12/03/2022]
Abstract
Exercise-induced leg pain is a common condition in athletes and in people involved in recreational sports. The diagnosis is not always straightforward: many conditions may cause exercise-induced leg pain. The aim of the present review is to provide a complete discussion of the most common pathologies related to this condition. Particular attention is dedicated to the history and the physical examination, which are fundamental for requesting the correct diagnostic tests or imaging techniques necessary for a precise diagnosis.
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Affiliation(s)
- Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Città della Salute e della Scienza, Torino, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, University of Torino, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
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22
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Mautner KR, Sussman WI. Intramuscular vascular malformations: a rare cause of exertional leg pain and a novel treatment approach with ultrasound-guided doxycycline sclerotherapy. Am J Sports Med 2015; 43:729-33. [PMID: 25535098 DOI: 10.1177/0363546514561003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Walter I Sussman
- Center for Rehabilitation Medicine, Emory University, Atlanta, Georgia, USA
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23
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Henry JC, Mouawad NJ, Phieffer L, Go MR. Tibial osteochondroma inducing popliteal artery compression. J Vasc Surg 2013; 61:1595-8. [PMID: 24360241 DOI: 10.1016/j.jvs.2013.10.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
Abstract
Compression of the neurovascular contents of the popliteal fossa is a rare condition that leads to exercise-induced pain and paresthesias in young athletes. Most frequently, it is caused by musculotendinous abnormalities resulting in popliteal entrapment syndrome. Bony abnormalities rarely are implicated but can produce symptoms that mimic popliteal entrapment syndrome. We present a patient with a tibial metaphysis osteochondroma inducing popliteal artery compression that was relieved after resection.
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Affiliation(s)
- Jon C Henry
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Nicolas J Mouawad
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura Phieffer
- Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael R Go
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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24
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Merz AE, Jimenez JC, Gelabert HA, Hame SL. Cystic adventitial disease of the popliteal artery causing intermittent exertional claudication in a young male athlete: a case report. Am J Sports Med 2013; 41:2573-6. [PMID: 23989350 DOI: 10.1177/0363546513501790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Alexa E Merz
- Sharon L. Hame, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, CHS 76-119, 10833 LeConte Avenue, Los Angeles, CA 90095-6902.
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