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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

O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício[*]

Article in several languages: 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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Resumo

A síndrome compartimental crônica é uma condição comum e frequentemente subdiagnosticada, induzida pelo exercício, que corresponde em média a um quarto dos casos de dor crônica na perna relacionada ao exercício, e que perde em frequência apenas para o espectro fratura/reação ao estresse tibial. Tradicionalmente ocorre em jovens atletas corredores, embora estudos mais recentes tenham demonstrado uma prevalência considerável em praticantes de atividade física de baixo rendimento, mesmo em pacientes de meia-idade ou idosos. A lista de diagnósticos diferenciais é extensa, e por vezes é difícil fazer a distinção apenas pelos dados clínicos, sendo necessários exames subsidiários.

Classicamente, o diagnóstico é feito pelo quadro clínico, pela exclusão dos diferenciais, e pela medida pressórica intracompartimental. Embora a manometria por agulha seja considerada o padrão-ouro no diagnóstico, seu uso não é universalmente aceito, visto que existem algumas limitações importantes, além da disponibilidade restrita do equipamento com agulha no Brasil. Recentemente, novos protocolos de manometria têm sido propostos a fim suplantar a deficiência dos tradicionais, com algum deles inclusive recomendando o uso sistemático da ressonância magnética (RM) na exclusão dos diagnósticos diferenciais. O uso de sequências de RM sensíveis a líquido pós-esforço é uma ótima opção não invasiva à manometria por agulha no diagnóstico da síndrome compartimental crônica, uma vez que o aumento da intensidade de sinal pós-exercício é estatisticamente relevante quando comparados os valores pressóricos de manometria em pacientes com a síndrome e assintomáticos; portanto, o exame pode ser usado no critério diagnóstico. O tratamento definitivo é a fasciotomia, embora existam alternativas menos eficazes.

Palavras-chave

síndromes compartimentais - exercícios - fraturas de estresse - ressonância magnética

* Trabalho realizado no Serviço de Radiologia Musculoesquelética do Grupo Fleury Medicina & Diagnóstico, São Paulo, SP, Brasil.




Publication History

Received: 05 July 2019

Accepted: 05 December 2019

Article published online:
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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