Download PDF
J Brachial Plex Peripher Nerve Inj 2009; 04(01): e115-e120
DOI: 10.1186/1749-7221-4-4
Case report
Williams et al; licensee BioMed Central Ltd.

Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome[*]

Eric H Williams
1   Division of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
2   Dellon Institutes for Nerve Surgery, Johns Hopkins University, 3333 North Calvert St. Suite 370, Baltimore, Maryland, 21218, USA
,
Don E Detmer
3   Department of Public Health Sciences, Health System, University of Virginia, Charlottesville, Virginia USA
,
Gregory P Guyton
4   Greater Chesapeake Orthopedic Surgery, 3333 North Calvert St, 4th Floor, Baltimore, Maryland, 21218, USA
,
A Lee Dellon
2   Dellon Institutes for Nerve Surgery, Johns Hopkins University, 3333 North Calvert St. Suite 370, Baltimore, Maryland, 21218, USA
› Author Affiliations
Subject Editor:
Further Information

Publication History

06 December 2008

16 May 2009

Publication Date:
18 September 2014 (online)

Also available at
  Permissions and Reprints

Abstract

Background Chronic exertional compartment syndrome (CECS) is characterized by elevated pressures within a closed space of an extremity muscular compartment, causing pain and/or disability by impairing the neuromuscular function of the involved compartment. The diagnosis of CECS is primarily made on careful history and physical exam. The gold standard test to confirm the diagnosis of CECS is invasive intra-compartmental pressure measurements. Sensory nerve function is often diminished during symptomatic periods of CECS. Sensory nerve function can be documented with the use of non-painful, non-invasive neurosensory testing.

Methods Non-painful neurosensory testing of the myelinated large sensory nerve fibers of the lower extremity were obtained with the Pressure Specified Sensory Device™ in a 25 year old male with history and invasive compartment pressures consistent with CECS both before and after running on a tread mill. After the patient’s first operation to release the deep distal posterior compartment, the patient failed to improve. Repeat sensory testing revealed continued change in his function with exercise. He was returned to the operating room where a repeat procedure revealed that the deep posterior compartment was not completely released due to an unusual anatomic variant, and therefore complete release was accomplished.

Results The patient’s symptoms numbness in the plantar foot and pain in the distal calf improved after this procedure and his repeat sensory testing performed before and after running on the treadmill documented this improvement.

Conclusion This case report illustrates the principal that non-invasive neurosensory testing can detect reversible changes in sensory nerve function after a provocative test and may be a helpful non-invasive technique to managing difficult cases of persistent lower extremity symptoms after failed decompressive fasciotomies for CECS. It can easily be performed before and after exercise and be repeated at multiple intervals without patient dissatisfaction. It is especially helpful when other traditional testing has failed.

*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


 

  • References

  • 1 Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med 1985; 13: 162-70 10.1177/036354658501300304 4014531
    CrossrefPubMedSearch in Google Scholar
  • 2 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: 35-40 10.1177/036354659001800106 2301689
    CrossrefPubMedSearch in Google Scholar
  • 3 Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc 2000; 32: S4-10 10.1097/00005768-200003001-00002 10730989
    PubMedSearch in Google Scholar
  • 4 Rorabeck CH, Bourne RB, Fowler PJ, Finlay JB, Nott L. The role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome. Am J Sports Med 1988; 16: 143-6 10.1177/036354658801600209 3377097
    CrossrefPubMedSearch in Google Scholar
  • 5 Styf J, Korner L, Suurkula M. Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome. J Bone Joint Surg Br 1987; 69: 301-5 3818765
    PubMedSearch in Google Scholar
  • 6 Brand JGvan den, Verleisdonk EJ, Werken Cvan der. Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome. Am J Sports Med 2004; 32: 452-6 10.1177/0363546503261733 14977673
    CrossrefPubMedSearch in Google Scholar
  • 7 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: 151-65 8418976
    CrossrefPubMedSearch in Google Scholar
  • 8 Rowdon GA, Richardson JK, Hoffmann P, Zaffer M, Barill E. Chronic anterior compartment syndrome and deep peroneal nerve function. Clin J Sport Med 2001; 11: 229-33 10.1097/00042752-200110000-00004 11753059
    CrossrefPubMedSearch in Google Scholar
  • 9 Dellon AL, Aszmann OC. Treatment of superficial and deep peroneal neuromas by resection and translocation of the nerves into the anterolateral compartment. Foot Ankle Int 1998; 19: 300-3 9622420
    CrossrefPubMedSearch in Google Scholar
  • 10 Williams EH, Williams CG, Rosson GD, Dellon LA. Anatomic site for proximal tibial nerve compression: a cadaver study. Ann Plast Surg 2009; 62: 322-5 10.1097/SAP.0b013e31817e9d81 19240533
    CrossrefPubMedSearch in Google Scholar
  • 11 Detmer DE. Chronic shin splints. Classification and management of medial tibial stress syndrome. Sports Med 1986; 3: 436-46 10.2165/00007256-198603060-00005 3787005
    CrossrefPubMedSearch in Google Scholar
  • 12 Brand JGvan den, Nelson T, Verleisdonk EJ, Werken Cvan der. 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: 699-704 10.1177/0363546504270565 15722275
    CrossrefPubMedSearch in Google Scholar
  • 13 Bourne RB, Rorabeck CH. Compartment syndromes of the lower leg. Clin Orthop Relat Res 1989; 97-104 2917448
    PubMedSearch in Google Scholar
  • 14 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: 29-34 10.1177/036354659001800105 2301688
    CrossrefPubMedSearch in Google Scholar
  • 15 Abraham P, Leftheriotis G, Saumet JL. Laser Doppler flowmetry in the diagnosis of chronic compartment syndrome. J Bone Joint Surg Br 1998; 80: 365-9 10.1302/0301-620X.80B2.7963 9546477
    CrossrefPubMedSearch in Google Scholar
  • 16 Phillips JH, Mackinnon SE, Beatty SE, Dellon AL, O’Brien JP. Vibratory sensory testing in acute compartment syndromes: a clinical and experimental study. Plast Reconstr Surg 1987; 79: 796-801 10.1097/00006534-198705000-00020 3575525
    CrossrefPubMedSearch in Google Scholar
  • 17 Dellon AL, Schneider RJ, Burke R. Effect of acute compartmental pressure change on response to vibratory stimuli in primates. Plast Reconstr Surg 1983; 72: 208-16 6308697
    CrossrefPubMedSearch in Google Scholar
  • 18 Dellon AL, Fine IT. A noninvasive technique for diagnosis of chronic compartment syndrome in the first dorsal interosseous muscle. J Hand Surg [Am] 1990; 15: 1008-9 10.1016/0363-5023(90)90034-O 2269770
    CrossrefPubMedSearch in Google Scholar
  • 19 Mohler LR, Styf JR, Pedowitz RA, Hargens AR, Gershuni DH. Intramuscular deoxygenation during exercise in patients who have chronic anterior compartment syndrome of the leg. J Bone Joint Surg Am 1997; 79: 844-9 10.1302/0301-620X.79B5.7602 9199381
    CrossrefPubMedSearch in Google Scholar
  • 20 Matsen 3rd FA, Mayo KA, Krugmire Jr RB, Sheridan GW, Kraft GH. A model compartmental syndrome in man with particular reference to the quantification of nerve function. J Bone Joint Surg Am 1977; 59: 648-53 141451
    PubMedSearch in Google Scholar
  • 21 Szabo RM, Gelberman RH, Williamson RV, Dellon AL, Yaru NC, Dimick MP. Vibratory sensory testing in acute peripheral nerve compression. J Hand Surg [Am] 1984; 9A: 104-9 6693727
    PubMedSearch in Google Scholar
  • 22 Dellon AL. Clinical use of vibratory stimuli to evaluate peripheral nerve injury and compression neuropathy. Plast Reconstr Surg 1980; 65: 466-76 10.1097/00006534-198004000-00011 7360814
    CrossrefPubMedSearch in Google Scholar
  • 23 Radoiu H, Rosson GD, Andonian E, Senatore J, Dellon AL. Comparison of measures of large-fiber nerve function in patients with chronic nerve compression and neuropathy. J Am Podiatr Med Assoc 2005; 95: 438-45 16166460
    CrossrefPubMedSearch in Google Scholar
  • 24 Dellon AL. Somatosensory Testing and Rehabilitation. American Occupational Therapy Association; Bethesda, USA: 1997
    Search in Google Scholar
  • 25 Wood WA, Wood MA, Werter SA, Menn JJ, Hamilton SA, Jacoby R, Dellon AL. Testing for loss of protective sensation in patients with foot ulceration: a cross-sectional study. J Am Podiatr Med Assoc 2005; 95: 469-74 16166466
    CrossrefPubMedSearch in Google Scholar
  • 26 Dellon AL, Keller KM. Computer-assisted quantitative sensorimotor testing in patients with carpal and cubital tunnel syndromes. Ann Plast Surg 1997; 38: 493-502 10.1097/00000637-199705000-00009 9160131
    CrossrefPubMedSearch in Google Scholar