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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(06): 673-680
DOI: 10.1055/s-0040-1702961
Artigo de Atualização
Artroscopia do esporte

The Role of Magnetic Resonance in the Diagnosis of Chronic Exertional Compartment Syndrome[*]

Artikel in mehreren Sprachen: português | English
Marcelo Astolfi Caetano Nico 
1   Serviço de Radiologia do sistema Musculoesquelético, Fleury Medicina & Saúde, São Paulo, SP, Brasil
,
Bruno Cerretti Carneiro 
1   Serviço de Radiologia do sistema Musculoesquelético, Fleury Medicina & Saúde, São Paulo, SP, Brasil
,
Fernando Ometto Zorzenoni 
1   Serviço de Radiologia do sistema Musculoesquelético, Fleury Medicina & Saúde, São Paulo, SP, Brasil
,
Alípio Gomes Ormond Filho 
1   Serviço de Radiologia do sistema Musculoesquelético, Fleury Medicina & Saúde, São Paulo, SP, Brasil
,
Julio Brandão Guimarães 
1   Serviço de Radiologia do sistema Musculoesquelético, Fleury Medicina & Saúde, São Paulo, SP, Brasil
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Abstract

Chronic compartment syndrome is a common and often underdiagnosed exercise-induced condition, accounting on average for a quarter of cases of chronic exertional pain in the leg, second only to the fracture/tibial stress syndrome spectrum. It traditionally occurs in young runner athletes, although more recent studies have demonstrated a considerable prevalence in low-performance practitioners of physical activity, even in middle-aged or elderly patients. The list of differential diagnoses is extensive, and sometimes it is difficult to distinguish them only by the clinical data, and subsidiary examinations are required. The diagnosis is classically made by the clinical picture, by exclusion of the differential diagnoses, and through the measurement of the intracompartmental pressure. Although needle manometry is considered the gold standard in the diagnosis, its use is not universally accepted, since there are some important limitations, apart from the restricted availability of the needle equipment in Brazil. New protocols of manometry have recently been proposed to overcome the deficiency of the traditional ones, and some of them recommend the systematic use of magnetic resonance imaging (MRI) in the exclusion of differential diagnoses. The use of post-effort liquid-sensitive MRI sequences is a good noninvasive option instead of needle manometry in the diagnosis of chronic compartment syndrome, since the increase in post-exercise signal intensity is statistically significant when compared with manometry pressure values in asymptomatic patients and in those with the syndrome; hence, the test can be used in the diagnostic criteria. The definitive treatment is fasciotomy, although there are less effective alternatives.

Keywords

compartment syndromes - exercises - stress fractures - magnetic resonance

* Work developed at the Musculoskeletal Radiology Service of the Fleury Group of Medicine & Diagnosis, São Paulo, SP, Brazil.




Publikationsverlauf

Eingereicht: 05. Juli 2019

Angenommen: 05. Dezember 2019

Artikel online veröffentlicht:
02. April 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Donaldson J, Haddad B, Khan WS. The pathophysiology, diagnosis and current management of acute compartment syndrome. Open Orthop J 2014; 8: 185-193
    CrossrefPubMedGoogle Scholar
  • 2 Reinking MF. Exercise Related Leg Pain (ERLP): a Review of The Literature. N Am J Sports Phys Ther 2007; 2 (03) 170-180
    PubMedGoogle Scholar
  • 3 Burrus MT, Werner BC, Starman JS. et al. Chronic leg pain in athletes. Am J Sports Med 2015; 43 (06) 1538-1547
    CrossrefPubMedGoogle Scholar
  • 4 Edmundsson D, Toolanen G. Chronic exertional compartment syndrome in diabetes mellitus. Diabet Med 2011; 28 (01) 81-85
    CrossrefPubMedGoogle Scholar
  • 5 Bong MR, Polatsch DB, Jazrawi LM, Rokito AS. Chronic exertional compartment syndrome: diagnosis and management. Bull Hosp Jt Dis 2005; 62 (3-4): 77-84
    PubMedGoogle Scholar
  • 6 Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc 2000; 32 (3, Suppl) S4-S10
    PubMedGoogle Scholar
  • 7 Roscoe D, Roberts AJ, Hulse D. Intramuscular compartment pressure measurement in chronic exertional compartment syndrome: new and improved diagnostic criteria. Am J Sports Med 2015; 43 (02) 392-398
    CrossrefPubMedGoogle Scholar
  • 8 Rajasekaran S, Finnoff JT. Exertional Leg Pain. Phys Med Rehabil Clin N Am 2016; 27 (01) 91-119
    CrossrefPubMedGoogle Scholar
  • 9 Vajapey S, Miller TL. Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature. Phys Sportsmed 2017; 45 (04) 391-398
    CrossrefPubMedGoogle Scholar
  • 10 Edmundsson D, Toolanen G, Sojka P. Chronic compartment syndrome also affects nonathletic subjects: a prospective study of 63 cases with exercise-induced lower leg pain. Acta Orthop 2007; 78 (01) 136-142
    CrossrefPubMedGoogle Scholar
  • 11 de Bruijn JAD, van Zantvoort APM, Winkes MB. et al. Lower Leg Chronic Exertional Compartment Syndrome in Patients 50 Years of Age and Older. Orthop J Sports Med 2018; 6 (03) 2325967118757179
    Google Scholar
  • 12 Beck JJ, Tepolt FA, Miller PE, Micheli LJ, Kocher MS. Surgical Treatment of Chronic Exertional Compartment Syndrome in Pediatric Patients. Am J Sports Med 2016; 44 (10) 2644-2650
    CrossrefPubMedGoogle Scholar
  • 13 Amendola A, Rorabeck CH, Vellett D, Vezina W, Rutt B, Nott L. The use of magnetic resonance imaging in exertional compartment syndromes. Am J Sports Med 1990; 18 (01) 29-34
    CrossrefPubMedGoogle Scholar
  • 14 Trease L, van Every B, Bennell K. et al. A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg. Eur J Nucl Med 2001; 28 (06) 688-695
    CrossrefPubMedGoogle Scholar
  • 15 Balduini FC, Shenton DW, O'Connor KH, Heppenstall RB. Chronic exertional compartment syndrome: correlation of compartment pressure and muscle ischemia utilizing 31P-NMR spectroscopy. Clin Sports Med 1993; 12 (01) 151-165
    CrossrefPubMedGoogle Scholar
  • 16 de Fijter WM, Scheltinga MR, Luiting MG. Minimally invasive fasciotomy in chronic exertional compartment syndrome and fascial hernias of the anterior lower leg: short- and long-term results. Mil Med 2006; 171 (05) 399-403
    CrossrefPubMedGoogle Scholar
  • 17 Tucker AK. Chronic exertional compartment syndrome of the leg. Curr Rev Musculoskelet Med 2010; 3 (1-4): 32-37
    CrossrefPubMedGoogle Scholar
  • 18 Braver RT. Chronic Exertional Compartment Syndrome. Clin Podiatr Med Surg 2016; 33 (02) 219-233
    CrossrefPubMedGoogle Scholar
  • 19 Brewer RB, Gregory AJ. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health 2012; 4 (02) 121-127
    CrossrefPubMedGoogle Scholar
  • 20 Bresler M, Mar W, Toman J. Diagnostic imaging in the evaluation of leg pain in athletes. Clin Sports Med 2012; 31 (02) 217-245
    CrossrefPubMedGoogle Scholar
  • 21 Aweid O, Del Buono A, Malliaras P. et al. Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin J Sport Med 2012; 22 (04) 356-370
    CrossrefPubMedGoogle Scholar
  • 22 Roberts A, Franklyn-Miller A. The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports 2012; 22 (05) 585-595
    CrossrefPubMedGoogle Scholar
  • 23 Howard JL, Mohtadi NG, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sport Med 2000; 10 (03) 176-184
    CrossrefPubMedGoogle Scholar
  • 24 Waterman BR, Laughlin M, Kilcoyne K, Cameron KL, Owens BD. Surgical treatment of chronic exertional compartment syndrome of the leg: failure rates and postoperative disability in an active patient population. J Bone Joint Surg Am 2013; 95 (07) 592-596
    CrossrefPubMedGoogle Scholar
  • 25 McCallum JR, Cook JB, Hines AC, Shaha JS, Jex JW, Orchowski JR. Return to duty after elective fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int 2014; 35 (09) 871-875
    CrossrefPubMedGoogle Scholar
  • 26 van den Brand JG, Nelson T, Verleisdonk EJ, van der Werken C. The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and near-infrared spectroscopy in chronic exertional compartment syndrome: a prospective study in 50 patients. Am J Sports Med 2005; 33 (05) 699-704
    CrossrefPubMedGoogle Scholar
  • 27 Hislop M, Tierney P. Intracompartmental pressure testing: results of an international survey of current clinical practice, highlighting the need for standardised protocols. Br J Sports Med 2011; 45 (12) 956-958
    CrossrefPubMedGoogle Scholar
  • 28 Winkes MB, Tseng CM, Pasmans HL, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Scheltinga MR. Accuracy of Palpation-Guided Catheter Placement for Muscle Pressure Measurements in Suspected Deep Posterior Chronic Exertional Compartment Syndrome of the Lower Leg: A Magnetic Resonance Imaging Study. Am J Sports Med 2016; 44 (10) 2659-2666
    CrossrefPubMedGoogle Scholar
  • 29 Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 1990; 18 (01) 35-40
    CrossrefPubMedGoogle Scholar
  • 30 Oliveira Junior O, Bertolini FM, Lasmar RP, Vieira RB, Mendes PM, Marcatti MM. Síndrome compartimental crônica nas pernas: relato de caso. Rev ABTPe 2016; 10 (02) 87-93
    Google Scholar
  • 31 Eskelin MK, Lötjönen JM, Mäntysaari MJ. Chronic exertional compartment syndrome: MR imaging at 0.1 T compared with tissue pressure measurement. Radiology 1998; 206 (02) 333-337
    CrossrefPubMedGoogle Scholar
  • 32 Verleisdonk EJ, van Gils A, van der Werken C. The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg. Skeletal Radiol 2001; 30 (06) 321-325
    CrossrefPubMedGoogle Scholar
  • 33 Litwiller DV, Amrami KK, Dahm DL. et al. Chronic exertional compartment syndrome of the lower extremities: improved screening using a novel dual birdcage coil and in-scanner exercise protocol. Skeletal Radiol 2007; 36 (11) 1067-1075
    CrossrefPubMedGoogle Scholar
  • 34 Ringler MD, Litwiller DV, Felmlee JP. et al. MRI accurately detects chronic exertional compartment syndrome: a validation study. Skeletal Radiol 2013; 42 (03) 385-392
    CrossrefPubMedGoogle Scholar
  • 35 Guermazi A, Roemer FW, Robinson P, Tol JL, Regatte RR, Crema MD. Imaging of Muscle Injuries in Sports Medicine: Sports Imaging Series. Radiology 2017; 282 (03) 646-663
    CrossrefPubMedGoogle Scholar
  • 36 Sigmund EE, Sui D, Ukpebor O. et al. Stimulated echo diffusion tensor imaging and SPAIR T2 -weighted imaging in chronic exertional compartment syndrome of the lower leg muscles. J Magn Reson Imaging 2013; 38 (05) 1073-1082
    CrossrefPubMedGoogle Scholar
  • 37 Wang JC, Criqui MH, Denenberg JO, McDermott MM, Golomb BA, Fronek A. Exertional leg pain in patients with and without peripheral arterial disease. Circulation 2005; 112 (22) 3501-3508
    CrossrefPubMedGoogle Scholar
  • 38 Gaunder C, McKinney B, Rivera J. Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome?. Case Rep Med 2017; 2017: 6981047
    CrossrefPubMedGoogle Scholar
  • 39 Joy SM, Raudales R. Popliteal Artery Entrapment Syndrome. Curr Sports Med Rep 2015; 14 (05) 364-367
    CrossrefPubMedGoogle Scholar
  • 40 Corneloup L, Labanère C, Chevalier L. et al. Presentation, diagnosis, and management of popliteal artery entrapment syndrome: 11 years of experience with 61 legs. Scand J Med Sci Sports 2018; 28 (02) 517-523
    CrossrefPubMedGoogle Scholar
  • 41 Pham TT, Kapur R, Harwood MI. Exertional leg pain: teasing out arterial entrapments. Curr Sports Med Rep 2007; 6 (06) 371-375
    PubMedGoogle Scholar
  • 42 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 (11) 2558-2566
    CrossrefPubMedGoogle Scholar