EILP Flashcards
aetiology CECS
unknown
vascular and neurogenic theories
vascular theory CECS
Neurogenic theory CECS
Ix for CECS
- dynamic intra-compartmental study = ONLY RELIABLE ONE
- pre/post-exercise MRI
- NIRS
- microdialysis
Pressure related condition- the other Ix don’t work well
Types of intra-compartment pressure studies
- Injection- A+E- good for acute but not chronic
- infusion technique- barely used
- non-infusion technique
- Micro-tip- doesn’t use catheter so doesn’t get blocked by fluid. Can only measure anterior compartment
Which tracing shows CECS?
2nd line- baseline pressure is never that low.
Pedowitz diagnostic criteria for CECS
Baseline resting pressure >15mmhg
1 min after stopping exercise ?30mmhg
at 5 minute >20 mmhg
CECS conservative Tx
Limited efficacy
- physio- acupuncture, trigger point release, deep massage
- orthoses
- botox- muscle perfuses during relaxation. By releasing muscle contraction can reverse cycle
Surgical Mx for CECS
- superficial fasciotomy
- fasciectomy
this is the only definitive treatment
Keep patient ACTIVE as soon as possible (if no drains)
6 weeks RTP if this is done correctly
endoscopic is the best- don’t need to cut entire leg
Post-op rehab for CECS by week
Sx superficial peroneal entrapment syndrome
- leg pain, relieved by rest within minutes
- non-specific anterior compartment
- UNILATERAL (unlike CECS)
- tightness, tenderness, ache and parasthesia near sock line
- young, active individuals
Ix for Superifical peroneal nerve entrapment syndrome (aka fibular nerve)
- diagnostic local anaesthetic- 0.5 chirocaine/marcaine (ask to run, when feel pain inject, then ask to run again and they feel no pain)
- nerve conduction studies
Mx SPNES
inject ? to atrophy fascia which is trapping peroneal nerve
Functional popliteal artery entrapment syndrome
Functional popliteal artery entrapment syndrome- common types
6 types, common are type 1+2
1: medial head of gastroc is normal but popliteal artery deviates more medially
2: medial head of gastroc is located laterally but popliteal artery is normal
Functional popliteal artery entrapment syndrome Ix
- duplex doppler USS- first line
- funcitonal ABPI- first line
- arteriography
- MRI/MRA- diagnostic
- CTA- useful to see arterial calcification
Functional popliteal artery entrapment syndrome Mx
Surgery to reconstruct popliteal artery
MTSS Hx
- pain in legs some during and mostly after exercise
- pain lasts hours-weeks after stopping
- site of pain lower 1/3rd of medial tibia (can be ant tibia)
- often change in intensity/duration/surface/shows etc
- can be bilateral or unilateral
Ix MTSS
- Plain radiograph rule out sarcoma etc
- isotope bone scan
- PET CT
- MRI = GOLD STANDARD
- bloods - female triad
MRI classification of MTSS
Fredericson classification system
- grade 1 = periosteal oedema
- grade 4 = fracture (rarely progresses to this)
Ddx for pain in anterior compartment LL
- CECS of AC
- Tibialis anterior muscle syndrome
Ddx for pain in posterior compartment LL
1) Popliteal artery entrapment syndrome
- radiculopathy
- low lying soleus / accessory soleus
- CECS of superificial posterior compartment
- myofascial tears
- myopathy
Ddx for pain in lower 1/3rd medial tibia
1) MTSS
- stress fracture
- CECS deep posterior compartment
Blood tests for LL pain
- vit B12
- Vit D
- CK
