Chapter 196 - Chronic exertional compartment syndrome

Question 1

First description of chronic exertional compartment syndrome

Answer 1

1912 Wilson

Question 2

First fasciotomy for CECS

Answer 2

Mavor on soccer player

Question 3

Mechanism of CECS

Answer 3

1) increased intracompartment pressure

2) transient ischemia

Question 4

Percentage growth of normal muscle in exercise

Answer 4

20%

Question 5

Risk factors for CECS

Answer 5

1) steroid use
2) atheletes
3) military personale

Question 6

Prevalence of CECS in patients with exercise-induced pain

Answer 6

10-60%

Question 7

Second most common causes of exercise-induced pain

Answer 7

stress fracture of tibia 25%

Question 8

Most common compartment of pain in CECS

Answer 8

Anterior

lateral

Question 9

Percent of CECS that are bilateral

Answer 9

70-80%

Question 10

Epidemiology of CECS

Answer 10

equal sex distribution

age 20’s

Question 11

Higher risk for CECS surgical failure

Answer 11

Co-existence deep posterior compartment syndrome

Question 12

Structures of the anterior compartment

Answer 12

1) deep peroneal nerve
2) anterior tibial artery
3) tibialis anterior
4) extensor muscle of the toe

Question 13

Structures of the lateral compartment

Answer 13

1) superficial peroneal nerve

2) peroneus longus and brevis muscle

Question 14

Structures of the superficial posterior compartment

Answer 14

1) gastrocnemius
2) soleus
3) sural nerve

Question 15

Structures of the deep posterior compartment

Answer 15

1) tibial nerve
2) posterior tibial artery
3) peroneal artery
4) tibialis posterior muscle
5) flexors of the toes

Question 16

Common symptoms of CECS in relationship to the compartment affected

Answer 16

1) anterior: weakness with dorsiflexion (deep peroneal)
2) lateral/superficial posterior: numbness of the dorsum of foot
3) deep posterior: weakness of plantarflexion (tibial never)

Question 17

Diagnosing CECS tools used

Answer 17

Intracompartmental pressure measurement with Stryker or arterial line

Question 18

Pedowitz diagnostic criteria of CECS

Answer 18

1) ICMP before exercise > 15 mmHg
2) 1 min after exercise > 30 mmHg
3) 5 min after exercise > 20 mm Hg

Exercise > 5 min to maximal tolerable pain

Question 19

Other adjuncts to ICMP for diagnosis of CECS

Answer 19

1) MRI

2) near-infrared spectroscopy

Question 20

Non-surgical treatment for CECS

Answer 20

1) icing
2) avoidance
3) physiotherapy
4) warm therapy
5) NSAID
6) lidocaine injection

all with poor success

Question 21

Rorabeck 1983 techniques for anterolateral compartment fasciotomy

Answer 21

1) two 4 cm vertical incisions separated by 15 cm skin bridge
2) incisions between fibula and crest of tibia
3) plane developed between both incisions
4) incise fascia and connect the incisions

Question 22

Open fasciectomy of anterior and lateral compartment

Answer 22

incision lateral to edge of tibia

2) 6 x 2 cm ellipse of fascia removed
3) fasciotomy of both compartments

Question 23

Posterior compartment release techique

Answer 23

1) 1-2 vertical incisions behind the posteromedial edge of tibia
2) GSV and saphenous nerve identified and protected
3) incise fascia
4) tibial attachment of soleus taken down
5) take down deep fascia to expose flexor digitorum longus

Question 24

Endoscopic compartmental release

Answer 24

1) transverse incision proximal leg just medial to fibular head
2) dissection plane to the loose areolar tissue
3) balloon dissector advaned to distal leg
4) direct visual release of fascia

Question 25

Complication of fasciotomy

Answer 25

1) neurological dysfunction (superficial peroneal neuritis) 5%

others rare:

2) infection
3) seroma
4) hematoma
5) DVT
6) wound complication

Question 26

success of CECS in symptoms relief

Answer 26

66%

recurrence 5-10%
6% need revision surgery

fasciotomy techniques make no difference

Question 27

Predictors of poor outcome

Answer 27

1) posterior compartment CECS
2) long duration of symptoms
3) female athletes