Intracompartmental Pressure Testing Dr Leesa Huguenin MP Sports Physicians wwwmpsportsphysicianscomau RECS 95 lower leg 45 anterior compartment Lateral deep posterior and superficial posterior ID: 661317
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Slide1
Recurrent
exertional compartment syndrome – Intracompartmental Pressure Testing
Dr Leesa Huguenin
MP Sports Physicians
www.mpsportsphysicians.com.auSlide2
RECS
95 % lower leg45% anterior compartmentLateral, deep posterior and superficial posterior
follow
85- 95% are bilateral
Also possible;Forearm (kayak, motorcross, sailboard)thigh, hands and rarely feetSlide3
Risk factors
Increased muscle swelling – genetic/ overuse/ biomechanical control
Increased
fascial
thickness/ toughness (?????)Reduced muscle capillary density? Creatine supplementation (transient)Slide4
Table 3 Diagnostic criteria of
intracompartmental pressure measurementAuthors Year Diagnostically relevant pressure values
French and Price" 1962
Postexercise
fall time <30 min in normal subjects,> 100 min in patientsReneman"7 1975 At six minutes postexercise pressure >15 cm H2O (11
mm Hg) above resting pressure
Puranen
" 1981 Mean pressure of 50 mm Hg during running. Resting
of no value, but did observe slow
postexercise
fall
McDermott3' 1982 Mean pressure of 85 mm Hg during running
Mubarak and Hargens5" 1982 Resting pressure >15 mm Hg. Exercise pressure >75
mm Hg. Pressure remains >30 mm Hg for >5 min after
exercise
Qvarfordt
et al" 1983 Pressures raised before, during, and after exercise.
Postexercise
decline 40 min. Ti 6
minWallensten
" 1983 No difference at rest, still raised 10 min
postexercise
(
anterior), returned to normal <10 min (deep posterior)
Detmer
et al" 1985 At rest, normal pressure < 15 mm Hg
Styf
and
Korner
" 1986 Muscle relaxation pressure
Styf
and Korner34 1986
Postexercise
pressure >35 mm Hg remained raised for >6
min (Also muscle relaxation pressure was raised during
exercise. >20 mins to return to normal)
Allen and Barnes" 1986 Exercise pressure >50 mm Hg anterior, >40 mm Hg deep
posterior No difference in resting pressures
Fronek
et al" 1987 Resting pressure .10 mm Hg and/or .25 mm Hg 5 min
after exercise
Rorabeck
et al'2 1988
Pre-exercise
pressure > 10 mm Hg and
postexercise
> 15 mm Hg for > 15 min
Styfs3 1988 Relaxation pressure >35 mm Hg, resting pressure >30
mm Hg,
postexercise
return to normal >6 min
Turnispeed
et al" 1989 > 20 mm Hg at rest (
postexercise
increase and slow
decline > 10 min)
Pedowitz
et
alr
1990
Pre-exercise
pressure .15 mm Hg, or
postexercise
pressure .30 mm Hg at
imin
or .20 mm Hg at 5 minSlide5
My guidelines
Resting pressures (post 1st exercise bout) 15-20mmHg +
1 min post exercise 30 - 35mmHg +
Slow recovery patterns, 5 mins > 20 mmHg
Fast recovery ?? Surgical successSlide6
COMPARTMENT PRESSURE STUDIES
STEP 1
PATIENT IS SENT OUT TO
EXERCISE TO ONSET OF SYMPTOMSSlide7
COMPARTMENT PRESSURE STUDIES
STEP 2
PATIENT RESTS ON BED –
ultrasound identification of popliteal
blood vessels
Injection of local anaesthetic down
to
periosteumSlide8
COMPARTMENT PRESSURE STUDIES
STEP 3
Insertion of split catheter
Plastic cannula inside needle remains in
Compartment as needle withdrawn,
Needle split and removedSlide9Slide10
COMPARTMENT PRESSURE STUDIES
STEP 4
Cannula is tested for flow and
Secured in place to avoid
kinkingSlide11
COMPARTMENT PRESSURE STUDIES
STEP 5
PATIENT IS EXERCISED –
SINGLE LEG HEEL RAISES TO FAILURESlide12
COMPARTMENT PRESSURE STUDIES
STEP 6
PATIENT LIES SUPINE, ANKLE SUPPORTED AT
90 DEGREES
PRESSURES MEASURED AT 1, 3 AND 5 MINS
EXTRA MEASURES IF SLOW RECOVERYSlide13
COMPARTMENT PRESSURE STUDIES
STEP 7
ADDITIONAL COMPARTMENTS TESTED
ANTERIOR/ LATERAL/ SUPERFICIAL
POSTERIORSlide14
COMPARTMENT PRESSURE STUDIES
STEP 8
COMPRESSION DRESSINGS APPLIED
PATIENT INSTRUCTED RE
ACTIVITY OVER NEXT 48 HOURS
AND DISCHARGED HOME WITH
EMERGENCY CONTACT NUMBERSSlide15
COMPARTMENT PRESSURE STUDIES
FEET!
ESSENTIALLY SAME PROTOCOLSlide16
COMPARTMENT PRESSURE STUDIES
COMPRESSION DRESSINGS STILL IMPORTANTSlide17
COMPARTMENT PRESSURE STUDIES
IT IS USUAL TO BE SORE 48 HOURS
= DOMS
COMPLICATIONS ARE RARE
BRUISE/ LOCAL BLEEDING
ACUTE COMPARTMENT SYNDROME
=SEVERE WORSENING PAIN
=
EARLY SURGERYSlide18
Thanks for your attentionSlide19Slide20