Chronic exertional compartment syndrome – the case for the trace. Guest blog by Drs Nat Padhiar & Osama Aweid

In our view, looking at intra-compartment pressure for the diagnosis of chronic exertional compartment syndrome (CECS) without visualising a pressure tracing is like trying to interpret an ECG without the ECG tracing. How do you know what is wrong with the cardiac muscle? We are not for one minute suggesting that the two conditions are the same, but would like to put forward an argument for intra-compartmental pressure (ICP) testing using a pressure tracing as a very useful and more objective tool in making a diagnosis of CECS.

A pressure tracing can provide the following data which can be very useful :

(1)  It allows an opportunity to check whether the catheter is in the right compartment and that the catheter is patent by squeezing the compartment that is being investigated (Fig.1 – below)

Fig.1. Squeezing the compartment being investigated causes a deflection, thus confirming correct placement of the catheter and ensuring its patency.

(2)  One can measure maximum, mean, relaxation and resting pressures (Fig.2. – below)

Fig.2. Dynamic ICP of 4 compartments showing on-line pressure tracing from which maximum, mean, relaxation and resting pressures can be calculated.

(3)  It can detect blockage at tip of the catheter, from wave form changes.

(4)  It can detect whether the catheter has slipped and sitting under the skin, from wave form changes.

(5)  It can detect whether it is part or fully in the blood vessel, from wave form changes.

(6)  In some patients, the increase in ICP is exercise specific. ICP with tracing allows for comparison between different exercises at the time of testing (Fig.3. below)

Fig.3. A Skater being tested on a training mat, activity that brought on his symptoms of CECS. His pressures between jogging on the spot and skating were vastly different in dimension and wave form.

Drs Osama Aweid & Nat Padhiar are co-authors of the systematic review article on ICP monitoring for the diagnosis of CECP in this month’s CJSM

References

Aweid, O; Del Buono, A; Malliaras P; Iqbal, Hassan; Morrissey D; Maffulli N, Padhiar N. Systematic Review and Recommendations for Intracompartmental Pressure Monitoring in Diagnosing Chronic Exertional Compartment Syndrome of the Leg. Clin J Sport Med 22(4): 356-370

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