PK|8@7XXrefs.MYD||7#Chambers, L. Hame, S. L. Levine, B.2011QAcute exertional medial compartment syndrome of the foot after playing basketball931-5Skeletal Radiol407 2011/04/16Acute Disease Adult Basketball/*injuries Compartment Syndromes/*diagnosis Cumulative Trauma Disorders/*diagnosis Foot/*pathology Humans Magnetic Resonance Imaging/*methods MaleJulDCompartment syndrome of the foot is an uncommon event. The most common cause of compartment syndrome of the foot is a crush injury. Exceedingly rare is acute compartment syndrome of the foot occurring in the absence of trauma. We describe the clinical scenario involving a 23-year-old healthy male who developed acute exertional compartment syndrome isolated to the medial compartment of the foot after playing basketball. The patient had no evidence of injury nor trauma, and the diagnosis was made based on physical exam, magnetic resonance imaging (MRI), and compartment pressure measurements. The patient did undergo successful fasciotomy on the day of presentation to the emergency department and has since completely recovered. We found four cases reported in the literature of acute exertional medial compartment syndrome of the foot in the absence of trauma or injury. This is the second case reported after playing basketball, while the others occurred after aerobics, a long distance run, and football. The most recent case was reported by Miozzari et al. [Am J Sports Med. 36(5):983-6, 2008] and involved a marathon runner who developed an isolated medial compartment syndrome of the foot. We would like to increase awareness of this uncommon clinical presentation in the absence of trauma and present the dramatic radiographic findings.+http://www.ncbi.nlm.nih.gov/pubmed/21494907Chambers, Lauchlan Hame, Sharon L Levine, Benjamin Case Reports Germany Skeletal radiology Skeletal Radiol. 2011 Jul;40(7):931-5. Epub 2011 Apr 15.*1432-2161 (Electronic) 0364-2348 (Linking)21494907Orthopaedic Surgery, University of California Los Angeles, Ronald Reagan Medical Center, 10833 Le Conte Ave., BOX 956902, 76-143 CHS, Los Angeles, CA 90095-6902, USA. klchambers@mednet.ucla.edu10.1007/s00256-011-1157-8eng |t7<Dahl, M. Hansen, P. Stal, P. Edmundsson, D. Magnusson, S. P.2011XStiffness and thickness of fascia do not explain chronic exertional compartment syndrome3495-500Clin Orthop Relat Res46912 2011/09/29DecBACKGROUND: Chronic exertional compartment syndrome is diagnosed based on symptoms and elevated intramuscular pressure and often is treated with fasciotomy. However, what contributes to the increased intramuscular pressure remains unknown. QUESTIONS/PURPOSES: We investigated whether the stiffness or thickness of the muscle fascia could help explain the raised intramuscular pressure and thus the associated chronic compartment syndrome symptoms. PATIENTS AND METHODS: We performed plain radiography, bone scan, and intramuscular pressure measurement to diagnose chronic compartment syndrome and to exclude other disorders. Anterior tibialis muscle fascial biopsy specimens from six healthy individuals, 11 patients with chronic compartment syndrome, and 10 patients with diabetes mellitus and chronic compartment syndrome were obtained. Weight-normalized fascial stiffness was assessed mechanically in a microtensile machine, and fascial thickness was analyzed microscopically. RESULTS: Mean fascial stiffness did not differ between healthy individuals (0.120 N/mg/mm; SD, 0.77 N/mg/mm), patients with chronic compartment syndrome (0.070 N/mg/mm; SD, 0.052 N/mg/mm), and patients with chronic compartment syndrome and diabetes (0.097 N/mg/mm; SD, 0.073 N/mg/mm). Similarly, no differences in fascial thickness were present. There was a negative correlation between fascial stiffness and intramuscular pressure in the patients with chronic compartment syndrome and diabetes. CONCLUSIONS: The lack of difference in fascial thickness and stiffness in patients with chronic compartment syndrome and patients with chronic compartment syndrome and diabetes compared with healthy individuals suggests structural and mechanical properties are unlikely to explain chronic compartment syndrome. To prevent chronic exertional compartment syndrome, it is necessary to address aspects other than the muscle fascia. LEVEL OF EVIDENCE: Level II, prognostic study. See the guidelines online for a complete description of level of evidence.+http://www.ncbi.nlm.nih.gov/pubmed/21948310Dahl, Morten Hansen, Philip Stal, Per Edmundsson, David Magnusson, S Peter Research Support, Non-U.S. Gov't United States Clinical orthopaedics and related research Clin Orthop Relat Res. 2011 Dec;469(12):3495-500. Epub 2011 Sep 24.*1528-1132 (Electronic) 0009-921X (Linking)321025521948310Institute of Sports Medicine, Department 8, Bispebjerg Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.10.1007/s11999-011-2073-xeng t|t71Diebal, A. R. Gregory, R. Alitz, C. Gerber, J. P.2011UEffects of forefoot running on chronic exertional compartment syndrome: a case series312-21Int J Sports Phys Ther64 2011/12/14DecINTRODUCTION: Chronic exertional compartment syndrome (CECS) is a condition that occurs almost exclusively with running whereby exercise increases intramuscular pressure compromising circulation, prohibiting muscular function, and causing pain in the lower leg. Currently, a lack of evidence exists for the effective conservative management of CECS. Altering running mechanics by adopting forefoot running as opposed to heel striking may assist in the treatment of CECS, specifically with anterior compartment symptoms. CASE DESCRIPTION: The purpose of this case series is to describe the outcomes for subjects with CECS through a systematic conservative treatment model focused on forefoot running. Subject one was a 21 y/o female with a 4 year history of CECS and subject two was a 21 y/o male, 7 months status-post two-compartment right leg fasciotomy with a return of symptoms and a new onset of symptoms on the contralateral side. OUTCOME: Both subjects modified their running technique over a period of six weeks. Kinematic and kinetic analysis revealed increased step rate while step length, impulse, and peak vertical ground reaction forces decreased. In addition, leg intracompartmental pressures decreased from pre-training to post-training. Within 6 weeks of intervention subjects increased their running distance and speed absent of symptoms of CECS. Follow-up questionnaires were completed by the subjects at 7 months following intervention; subject one reported running distances up to 12.87 km pain-free and subject two reported running 6.44 km pain-free consistently 3 times a week. DISCUSSION: This case series describes a potentially beneficial conservative management approach to CECS in the form of forefoot running instruction. Further research in this area is warranted to further explore the benefits of adopting a forefoot running technique for CECS as well as other musculoskeletal overuse complaints.+http://www.ncbi.nlm.nih.gov/pubmed/22163093Diebal, Angela R Gregory, Robert Alitz, Curtis Gerber, J Parry United States International journal of sports physical therapy Int J Sports Phys Ther. 2011 Dec;6(4):312-21.2159-2896 (Electronic)323015922163093eng T||74Edmundsson, D. Toolanen, G. Thornell, L. E. Stal, P.2010_Evidence for low muscle capillary supply as a pathogenic factor in chronic compartment syndrome805-13Scand J Med Sci Sports206 2009/10/07#Adolescent Adult *Capillaries Case-Control Studies Chronic Disease Compartment Syndromes/etiology/*pathology/surgery Exercise Test Female Humans Immunohistochemistry Male Microcirculation Middle Aged Muscle, Skeletal/*blood supply Myosin Heavy Chains/analysis Prospective Studies Young AdultDecKThere is a paucity of data regarding the pathogenesis of chronic exertional compartment syndrome (CECS), its consequences for the muscles and the effects of treatment with fasciotomy. We analyzed biopsies from the tibialis anterior muscle, from nine patients, obtained during a decompressing fasciotomy and during follow-up 1 year later. Control biopsies were obtained from nine normal subjects. Muscle capillarity, fiber-type composition and fiber area were analyzed with enzyme- and immunohistochemistry and morphometry. At baseline, CECS patients had lower capillary density (273 vs 378 capillaries/mm(2) , P=0.008), lower number of capillaries around muscle fibers (4.5 vs 5.7, P=0.004) and lower number of capillaries in relation to the muscle fiber area (1.1 vs 1.5, P=0.01) compared with normal controls. The fiber-type composition and fiber area did not differ, but focal signs of neuromuscular damage were observed in the CECS samples. At 1-year follow-up after fasciotomy, the fiber area and the number of fibers containing developmental myosin heavy chains were increased, but no enhancement of the capillary network was detected. Thus, morphologically, patients with CECS seemed to have reduced microcirculation capacity. Fasciotomy appeared to trigger a regenerative response in the muscle, however, without any increase in the capillary bed.+http://www.ncbi.nlm.nih.gov/pubmed/19804582Edmundsson, D Toolanen, G Thornell, L-E Stal, P Research Support, Non-U.S. Gov't Denmark Scandinavian journal of medicine & science in sports Scand J Med Sci Sports. 2010 Dec;20(6):805-13. doi: 10.1111/j.1600-0838.2009.01013.x.*1600-0838 (Electronic) 0905-7188 (Linking)19804582qDepartment of Surgery and Perioperative Science, Division of Orthopedics, Umea University Hospital, Umea, Sweden..10.1111/j.1600-0838.2009.01013.x SMS1013 [pii]eng||70Edwards, P. H., Jr. Wright, M. L. Hartman, J. F.2005VA practical approach for the differential diagnosis of chronic leg pain in the athlete1241-9Am J Sports Med338 2005/08/03Algorithms Compartment Syndromes/*diagnosis Diagnosis, Differential Fractures, Stress/*diagnosis Humans *Leg Nerve Compression Syndromes/*diagnosis Pain/diagnosis/*etiology Peroneal Neuropathies *Sports Tibial Fractures/diagnosisAugChronic lower leg pain results from various conditions, most commonly, medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome. Symptoms associated with these conditions often overlap, making a definitive diagnosis difficult. As a result, an algorithmic approach was created to aid in the evaluation of patients with complaints of lower leg pain and to assist in defining a diagnosis by providing recommended diagnostic studies for each condition. A comprehensive physical examination is imperative to confirm a diagnosis and should begin with an inquiry regarding the location and onset of the patient's pain and tenderness. Confirmation of the diagnosis requires performing the appropriate diagnostic studies, including radiographs, bone scans, magnetic resonance imaging, magnetic resonance angiography, compartmental pressure measurements, and arteriograms. Although most conditions causing lower leg pain are treated successfully with nonsurgical management, some syndromes, such as popliteal artery entrapment syndrome, may require surgical intervention. Regardless of the form of treatment, return to activity must be gradual and individualized for each patient to prevent future athletic injury.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16061959Edwards, Peter H Jr Wright, Michelle L Hartman, Jodi F United States The American journal of sports medicine Am J Sports Med. 2005 Aug;33(8):1241-9.%0363-5465 (Print) 0363-5465 (Linking)16061959uOhio Orthopedic Center of Excellence, 4605 Sawmill Road, Upper Arlington, OH 43220, USA. www.pedward3@columbus.rr.com(33/8/1241 [pii] 10.1177/0363546505278305eng ||7bLitwiller, D. V. Amrami, K. K. Dahm, D. L. Smith, J. Laskowski, E. R. Stuart, M. J. Felmlee, J. P.2007Chronic exertional compartment syndrome of the lower extremities: improved screening using a novel dual birdcage coil and in-scanner exercise protocol1067-75Skeletal Radiol3611 2007/08/19uAnterior Compartment Syndrome/*diagnosis Artifacts Chronic Disease Equipment Design Female Humans Image Enhancement/instrumentation Image Processing, Computer-Assisted/methods Isometric Contraction/physiology Magnetic Resonance Imaging/*instrumentation/methods Muscle, Skeletal/physiology Phantoms, Imaging Physical Exertion/physiology ROC Curve Sensitivity and SpecificityNovOBJECTIVE: The purpose of this study was to design and evaluate an MRI screening protocol for chronic exertional compartment syndrome (CECS) of the lower legs using an in-scanner exercise protocol and novel dual birdcage coil design for improved imaging. MATERIALS AND METHODS: Coil and phantom studies: a custom-made dual birdcage coil designed for this protocol was evaluated for uniformity and signal-to-noise ratio (SNR) compared with a conventional phased-array receive-only torso coil and the body coil. Phantom and normal subject studies were performed to confirm coil performance. In-vivo studies: eight unaffected subjects and 42 patients with lower extremity symptoms suggestive of CECS were imaged with the dual birdcage coil and an in-scanner exercise protocol which included imaging at rest, during isometric resisted dorsi flexion, at rest (recovery), during isometric resisted plantar flexion and, again, at rest. Of 42 patients, 14 had confirmed CECS and 28 had lower extremity anomalies attributable to other causes. Ratios of relative T2-weighted signal intensities were calculated for exercise and recovery images compared to baseline after processing of images, including re-registration for motion, smoothing and segmentation to remove bone and pulsation artifacts from blood vessels. RESULTS: Receiver operating characteristic (ROC) analysis showed a threshold for the ratio of relative T2-weighted signal intensity of 1.54 to have a sensitivity of 96%, specificity of 90% and accuracy of 96% for CECS. Patients with CECS had their peak ratio of signal intensity compared with baseline during the first recovery period after isometric dorsi flexion, whereas unaffected subjects and patients with other causes of exercise-induced lower extremity pain reached their peak values during exercise (P<0.001). CONCLUSION: We have developed the first in-scanner MRI exercise protocol for the assessment of patients with suspected CECS. The technique shows high accuracy, sensitivity and specificity for diagnosis in this small cohort of patients with CECS. Further study may allow this non-invasive test to be used as a triage tool for invasive intracompartmental pressure measurements in patients with suspected CECS.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17701169Litwiller, Daniel V Amrami, Kimberly K Dahm, Diane L Smith, Jay Laskowski, Edward R Stuart, Michael J Felmlee, Joel P Comparative Study Germany Skeletal radiology Skeletal Radiol. 2007 Nov;36(11):1067-75. Epub 2007 Aug 15.%0364-2348 (Print) 0364-2348 (Linking)17701169kMR Research Laboratory, Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.10.1007/s00256-007-0360-0eng||7#Popovic, N. Bottoni, C. Cassidy, C.2011KUnrecognized acute exertional compartment syndrome of the leg and treatment265-9Acta Orthop Belg772 2011/06/15Acute Disease Compartment Syndromes/*diagnosis/*etiology/pathology/surgery Disease Progression Gait Disorders, Neurologic/etiology/surgery Humans Leg/surgery Male Muscle, Skeletal/pathology Peroneal Neuropathies/etiology/surgery *Soccer Tendon Transfer Young AdultAprtAcute-on-chronic exertional compartment syndrome is rare and may be easily missed without a high degree of awareness and clinical suspicion. We report a case of unrecognized acute-on-chronic exertional compartment syndrome in a recreational soccer player. The late sequela of this condition, foot drop, was successfully treated with transfer of the peroneus longus tendon.+http://www.ncbi.nlm.nih.gov/pubmed/21667742Popovic, Nebojsa Bottoni, Craig Cassidy, Charles Case Reports Belgium Acta orthopaedica Belgica Acta Orthop Belg. 2011 Apr;77(2):265-9.%0001-6462 (Print) 0001-6462 (Linking)21667742aAspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. Nebojsa.popovic@aspetar.comengF|7Roberts, A. Franklyn-Miller, A.2011lThe validity of the diagnostic criteria used in chronic exertional compartment syndrome: A systematic reviewScand J Med Sci Sports 2011/11/19Sep 13JChronic exertional compartment syndrome (CECS) of the lower limb is part of a group of overuse lower limb injuries with common presenting features. It is commonly diagnosed by the measurement of raised intramuscular pressures in the lower limb. The pathophysiology of the condition is poorly understood, and the criteria used to make the diagnosis are based on small sample sizes of symptomatic patients. We carried out a systematic review to compare intramuscular pressures in the anterior compartment of healthy subjects with commonly used criteria for CECS. Thirty-eight studies were included. With the exception of relaxation pressure, the current criteria for diagnosing CECS, considered to be the gold standard, overlap the range found in normal healthy subjects. Several studies reported mean pressures that would prompt a positive diagnosis for CECS, despite none of the subjects reporting any symptoms. The intramuscular pressure at all time points has also shown to vary in relation to a number of other factors other than the presence of CECS. Taken together, these data have major implications on the ability to use these published criteria for diagnosis and question the underlying pathophysiology. Clinicians are recommended to use protocol-specific upper confidence limits to guide the diagnosis following a failed conservative management.+http://www.ncbi.nlm.nih.gov/pubmed/22092446Journal article Scandinavian journal of medicine & science in sports Scand J Med Sci Sports. 2011 Sep 13. doi: 10.1111/j.1600-0838.2011.01386.x.*1600-0838 (Electronic) 0905-7188 (Linking)22092446tCentre for Human Performance, Rehabilitation and Sports Medicine, Defence Medical Rehabilitation Centre, Surrey, UK. 10.1111/j.1600-0838.2011.01386.xEng||7 Tubb, C. C. Vermillion, D.2001QChronic exertional compartment syndrome after minor injury to the lower extremity366-8Mil Med1664 2001/04/24Adult Baseball/*injuries Compartment Syndromes/*etiology/surgery *Exercise Female Humans Leg Injuries/*complications Military Personnel Wounds, Nonpenetrating/*complicationsAproSince the 1950s, chronic exertional compartment syndrome of the lower leg has been thoroughly reported in the literature. The predisposing factors and pathophysiology of this condition, however, still are not fully understood. We present a case of a well-conditioned individual who developed a chronic exertional compartment syndrome of the left lower leg anterior compartment after a direct blow injury during a softball game. Trauma is not routinely implicated as a risk factor for chronic compartment syndrome, and the literature on this topic is scarce. We suggest that trauma, even low-velocity trauma, may precipitate a chronic exertional compartment syndrome. We review the literature regarding chronic exertional compartment syndromes preceded by trauma and offer explanations regarding the mechanisms by which a traumatic event may induce a chronic compartment syndrome.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11315483dTubb, C C Vermillion, D Case Reports United States Military medicine Mil Med. 2001 Apr;166(4):366-8.%0026-4075 (Print) 0026-4075 (Linking)11315483<U.S. Army Health Clinic Friedberg, Unit 21108, APO AE 09074.eng|t7 Tucker, A. K.20102Chronic exertional compartment syndrome of the leg32-7Curr Rev Musculoskelet Med31-4 2010/11/11Chronic exertional compartment syndrome (CECS) is an underdiagnosed cause of chronic exertional leg pain. The syndrome most commonly occurs in young adult recreational runners, elite athletes, and military recruits. CECS is caused by increased intracompartmental pressure within a fascial space; however, the mechanism of why pain occurs is unknown. Symptoms are classically pain in the affected compartment at the same time, distance, or intensity of exercise. CECS is a clinical diagnosis; however, it is confirmed by intracompartmental pressure testing. Fasciotomy is the treatment of choice for athletes who would like to maintain the same level of activity. Athletes who have a release of the anterior and lateral compartments have a high success rate.+http://www.ncbi.nlm.nih.gov/pubmed/21063498~Tucker, Alicia K United States Current reviews in musculoskeletal medicine Curr Rev Musculoskelet Med. 2010 Sep 2;3(1-4):32-7.1935-9748 (Electronic)294157921063498LChristiana Care Health System, Wilmington, DE. USA. aliciatucker@hotmail.com10.1007/s12178-010-9065-4eng||7 Wilder, R. P. Magrum, E.2010Exertional compartment syndrome429-35Clin Sports Med293 2010/07/09Anterior Compartment Syndrome/diagnosis/*etiology Chronic Disease Diagnosis, Differential Humans Muscular Diseases/diagnosis/etiology *Physical Exertion Risk Factors Running/*injuriesJul5Chronic exertional compartment syndrome should be considered in any runner experiencing exertional leg pain. Runners typically describe a tight, cramping ache over the involved compartment that commences at a reproducible point in the run and resolves with rest. Diagnosis should include a careful history and physical examination as well as documentation with intramuscular compartment pressure monitoring. Milder cases will resolve with activity modification and conservative care. More severe cases or those failing conservative care are referred for fasciotomy.+http://www.ncbi.nlm.nih.gov/pubmed/20610031nWilder, Robert P Magrum, Eric United States Clinics in sports medicine Clin Sports Med. 2010 Jul;29(3):429-35.*1556-228X (Electronic) 0278-5919 (Linking)20610031oDepartment of PM&R, University of Virginia, 545 Ray C. Hunt, Charlottesville, VA 22901, USA. rpw4n@virginia.edu5S0278-5919(10)00023-2 [pii] 10.1016/j.csm.2010.03.008engPK)8@I/**refs.frm 0B< !// !HPRIMARYyearIndex 6ByP/) idreference_type text_stylesauthoryear title pages secondary_title volume numbernumber_of_volumessecondary_authorplace_published publishersubsidiary_authoredition keywords type_of_workdate2)  abstractlabelurltertiary_titletertiary_author notes isbn custom_1 custom_2 custom_3 custom_4alternate_titleaccession_number call_number short_title custom_5 custom_6sectionoriginal_publicationH) reprint_editionreviewed_itemauthor_addressimagecaption custom_7 electronic_resource_number link_to_pdf translated_author translated_titlename_of_databasedatabase_providerresearch_notes language access_datelast_modified_date !! H!H!H! (H! 3H! >H! IH! TH!_H!jH!uH! H!H!H! H! H!H! H!H!H!H!H! H! H! H! H! %H! 0H!;H!FH! QH! \H! gH! rH!}H!H!H!H!H!H!H! H! H! H! H! H!H! H!H! "H! -H!8H!idreference_typetext_stylesauthoryeartitlepagessecondary_titlevolumenumbernumber_of_volumessecondary_authorplace_publishedpublishersubsidiary_authoreditionkeywordstype_of_workdateabstractlabelurltertiary_titletertiary_authornotesisbncustom_1custom_2custom_3custom_4alternate_titleaccession_numbercall_numbershort_titlecustom_5custom_6sectionoriginal_publicationreprint_editionreviewed_itemauthor_addressimagecaptioncustom_7electronic_resource_numberlink_to_pdftranslated_authortranslated_titlename_of_databasedatabase_providerresearch_noteslanguageaccess_datelast_modified_datePK|8@7XXrefs.MYDPK)8@I/**Yrefs.frmPKl