Module 8 - Sport-Related Vascular Conditions Flashcards
What are the four sport-related vascular conditions in endurance athletes?
- Flow limitations in the Iliac Artery
- Adductor Canal Compression / Venous Outflow Syndrome
- Popliteal Artery Entrapment Syndrome
- Chronic Exertional Compartment Syndrome
What is FLIA?
- Flow limitations in the Iliac Artery
What is PAES?
- Popliteal Artery Entrapment Syndrome
What is CECS?
- Chronic Exertional Compartment Syndrome
What are Flow limitations in the Iliac Artery?
- Blood flow limitation during exercise
What do Flow limitations in the iliac artery consist of?
- Functional Stenosis
- Structural Stenosis
What is Functional Stenosis?
- Artery is compressed
- Kinked by a combination of surrounding tissue & anatomical/biomechanical position
What is Structural Stenosis?
- The artery wall itself undergoes maladaptive changes (endofibrosis)
How do the symptoms of Flow limitations in the Iliac Artery change over time?
- Begins non-specific
- Progressive months - years
Why are the initial symptoms of Flow limitations in the iliac artery difficult to detect?
Difficult to differentiate from:
- Normal Exertional Discomfort
- Common Musculoskeletal injuries
- Overuse
- Overtraining
What are the non-specific symptoms of flow limitations in the iliac artery?
- Pain
- Burning
- Powerlessness
What are the symptoms of FLIA?
- Ischemia
- Hypoxia
- Claudication
What is Claudication?
- pain in your thigh, calf, or buttocks that happens when you walk
What is the progression that occurs with FLIA?
- Functional to structural stenosis
- Worsening symptoms
- Earlier onset
- Slower Recovery
What are some risk factors for FLIA?
- cycling
- extreme body position
- long training hours
- high demand for O2 delivery
How do you assess FLIA?
- Questionnaire
- Exclusionary tests
- Functional Assessment
- Maximal Ramp Exercise Test
What is an Ankle-Brachial PRessure Index?
- Blood pressure at ankle(s) will be reduced if flow is limited
- Comparing both legs to each other, and to arm
What is the specialist clinical evaluation of FLIA?
- Echo-Doppler Ultrasound Imaging
What is echo-doppler ultrasound imaging?
- imaging at rest, after exercise and with muscle contraction
- observe artery diameter, course, possible kink
- compare bilaterally
What does echo-doppler ultrasound imaging view?
- Arterial kink
- excessive length (tortuosity)
- endofibrosis / stenosis
What causes maladaptive endofibrosis?
- Artery thickens to resist turbulent flow
What are some bike and body positions that can reduce the risk of FLIA?
- Upright handlebar, closer to body
- Forward Saddle
- Shorter Cranks
- Rearward Cleat Position
- Flat Shoes
What are some biomechanical techniques used to reduce the risk of FLIA?
- Reduce active pulling on the upstroke
- Push down harder
How does reducing active pulling on the upstroke of cycling reduce the risk of FLIA?
- Decrease Psoas recruitment
- Increase Glutes Recruitment
What training modifications can you make to reduce the risk of FLIA?
Decrease
- Intensity
- Volume
- Volume of Intensity
- Symptoms
What should training zones account for?
- Symptoms
What exercises can be done to reduce the risk of FLIA?
- Core, hips & lumbar stabilization
- Must be individualized
What symptoms of FLIA might need surgical management?
- Arterial kink
- Excessive Length (tortuosity)
- Endofibrosis / stenosis (narrowing)
What is the surgical management of a lengthened iliac artery?
- Surgical shortening
What is the surgical management of an artery that is predisposed to kink?
- artery excised from surrounding tissues
Describe Adductor Canal Compression / Venous Outflow Syndrome
- Superficial Femoral aa. & vv. compression
- Hypertrophied Quad & Adductor mm.
What are the symptoms of Adductor Canal Compression / Venous Outflow Syndrome?
- Ischemia
- Hypoxia
- Claudication
- Swelling
- Heaviness
- Paraesthesia
What is the management of adductor canal compression/venous outflow syndrome?
- Surgical Release
What happens during a 60-sec isometric contraction?
- blood volume pushed out
- During relaxation, blood volume flow back in
What is NIRS reoxygenation sensitive to?
- Severity of arterial flow limitations
Why might there be back flow of deoxygenated blood? How can it be identified?
Why
- Upstream outflow limitation
How Identified
- Near-infrared spectrometry
What can NIRS identify? what can it not?
Can
- back-flow of deoxygenated blood
Can Not
- upstream limitation location
What is adductor canal compression / venous outflow syndrome?
- Mechanical compression of microvasculature
Describe the mechanical compression of microvasculature that occurs with adductor canal compression / venous outflow syndrome
- Local compression from hypertrophied muscle
- ‘Up-stream’ venous compression
What occurs with the mechanical compression of microvasculature that occurs with adductor canal compression/venous outflow syndrome?
- ‘backflow’ of deoxygenated (venous) blood volume on muscle relax
Describe Popliteal Artery Entrapment Syndrome
- Compression of Artery, Vein, Nerve
What are the types of popliteal artery entrapment syndrome?
- Structural
- Functional
What subtypes of popliteal artery entrapment syndrome are there?
- I-VI & F
When is structural popliteal artery entrapment syndrome most common?
- males > 40
When is functional popliteal artery entrapment syndrome most common?
- Females < 40
What are the symptoms of popliteal artery entrapment syndrome?
- Claudication
- Swelling
- Fullness
- Paraesthesia
What is the diagnosis of popliteal artery entrapment syndrome?
- Provocative testing
- Duplex Ultrasound Imaging
- MR angiography, CT scan
What are provocative testing diagnostics of popliteal artery entrapment syndrome?
- exercise
- calf raises
What does duplex ultrasound imaging test for?
- Peak systolic velocity
What can MR angiography, CT scan result in when testing for Popliteal Artery Entrapment Syndrome?
- High False Positives
What are some potential injuries that could present like popliteal artery entrapment syndrome?
- Tibial Fracture
- Compartment Syndrome
- Bursitis
- Nerve Entrapment
- Referred Pain Sciatica
- Muscle Strain
What are some complications with Popliteal Artery Entrapment Syndrome?
- Thrombosis (clot blocking vein)
- Embolism (detached piece of thromboembolus)
What are some management techniques for popliteal artery entrapment syndrome?
- Soft tissue treatment
- Botox Injections
- Surgical decompression (fasciotomy, myotomy)
- Vascular repair, re-routing, bypass
What is Chronic Exertional Compartment Syndrome ?
- Compression of Fascial Compartments
- Muscle, Artery, Vein, Nerve
What is Chronic Exertional Compartment Syndrome caused by?
- Mechanical pressure
What are the symptoms of Chronic Exertional Compartment Syndrome?
- Claudication
- Paraesthesia
- Fullness
- Weakness
- Swelling
- Hernia
- Hypoxia
- Ischemia
- Nervous Sensory Disruption
Describe the onset and recovery of chronic exertional compartment syndrome
To Start
- Gradual onset during training
- Rapid Recovery
Over time
- Faster onset
- Slower recovery
Does chronic exertional compartment syndrome impact one side more than the other?
Sometimes but:
- commonly bilateral
What is an important sign of chronic exertional compartment syndrome progression?
- Earlier onset and slower recovery
What is used to diagnose chronic exertional compartment syndrome?
- Needle manometry pressure testing
- NIRS muscle oxygenation
What is the management technique used to treat chronic exertional compartment syndrome?
- Manual Therapies (not very effective)
- Surgery - Fasciotomy
- Training modification / reduction
- Forefoot running
What is Acute Compartment Syndrome?
- Severe Tissue Ischemia
What is is the usual cause of acute compartment syndrome?
- Often Direct Trauma
What are the symptoms of Acute Compartment Syndrome?
- Paresthesia
- Weakness
- Paralysis
- Pain “out of proportion to injury”
What is the treatment for acute compartment syndrome?
Surgical
- Fasciotomy
