Exercise induced pain in the posterior part of the leg is common among runners; the
underlying reason for these complaints may be very different. The purpose of the present,
controlled study was therefore 1. to confirm a clinically diagnosed deep posterior
compartment syndrome by using intramuscular pressure measurements and 2. to evaluate
the effect of a surgical release on clinical signs and intracompartment pressure values.
Fifteen symptomatic runners with the clinical suspicion of a chronic deep posterior
compartment syndrome and nine healthy recreational runners as controls were investigated.
Intramuscular pressure was measured both at rest and up to two minutes post-exercise,
using a pressure-monitor with a transducer. In symptomatic runners, the average pressure
was pre-operatively 5.6 mmHg (95 %-confidence-interval [Cl]: 3.4 - 7.6) at rest, rising
to 18.5 mmHg (Cl: 15.4 - 21.8) post-exercise. Corresponding values in healthy control
runners were 5.1 mmHg (Cl: 1.9 - 8.3) at rest, with a decrease induced by exercise
to 2.8 mmHg (CI: -0.5 - 6.1). After fasciotomy of the deep posterior compartment in
all fifteen symptomatic runners, average pressure values fell to 2.2 mmHg (Cl:1.0
- 3.4) at rest, and were further reduced after (now pain-free) exercise to 1.6 mmHg
(Cl: 0.6 -2.6). The decrease between pre-operative and post-operative values was statistically
highly significant (p < 0.0001 for values after running, p < 0.005 for values at rest).
In conclusion, intracompartment pressure measurement is a useful technique to confirm
the clinical diagnosis of deep posterior compartment syndrome prior to recommending
surgery. Hereby, an exercise-induced rise in pressure of at least 10 mmHg, corresponding
to a two- to threefold increase of values measured at rest, may be a more important
diagnostic criterion than absolute levels of pressure measured before or after running.
Key words
Chronic deep posterior compartment syndrome - diagnosis - intracompartmental pressure
- fasciotomy - runners
