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Semin Musculoskelet Radiol 2010; 14(2): 236-244
DOI: 10.1055/s-0030-1253164
© Thieme Medical Publishers

Compartment Syndromes

Scott McDonald1 , Philip Bearcroft1
  • 1Department of Radiology, Addenbrookes Hospital, Cambridge, United Kingdom
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Publication History

Publication Date:
18 May 2010 (online)

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ABSTRACT

Compartment syndrome can be defined as increased tissue pressure within a closed myofascial space, resulting in disturbed microcirculation and the potential for irreversible neuromuscular ischemic damage. It may present either acutely or chronically. Acute compartment syndrome most commonly occurs following lower limb trauma, and emergency decompression through open and extensive fasciotomies is the treatment of choice. There is little place for imaging in the acute setting because the diagnosis should be made on clinical grounds, possibly supported by measurements of compartmental pressure. Chronic compartment syndrome is more common, usually presenting with recurrent episodes of pain on exercise. The demonstration of elevated compartment pressures following exercise is currently the gold standard method for diagnosis. There is increasing interest in the use of imaging as either a potential alternative to compartmental pressure measurement or as an initial screening investigation prior to invasive testing. The literature evaluating the use of imaging techniques is reviewed, with an emphasis on the potential role of postexertional magnetic resonance imaging.

KEYWORDS

Compartment syndrome - imaging - radiology - MRI

REFERENCES

  • 1 Elliott K G, Johnstone A J. Diagnosing acute compartment syndrome.  J Bone Joint Surg Br. 2003;  85(5) 625-632
    PubMedGoogle Scholar
  • 2 Bird C B, McCoy Jr J W. Weight-lifting as a cause of compartment syndrome in the forearm. A case report.  J Bone Joint Surg Am. 1983;  65(3) 406
    PubMedGoogle Scholar
  • 3 Kahan J S, McClellan R T, Burton D S. Acute bilateral compartment syndrome of the thigh induced by exercise. A case report.  J Bone Joint Surg Am. 1994;  76(7) 1068-1071
    PubMedGoogle Scholar
  • 4 Wasilewski S A, Asdourian P L. Bilateral chronic exertional compartment syndromes of forearm in an adolescent athlete. Case report and review of literature.  Am J Sports Med. 1991;  19(6) 665-667
    CrossrefPubMedGoogle Scholar
  • 5 Nakhostine M, Styf J R, van Leuven S, Hargens A R, Gershuni D H. Intramuscular pressure varies with depth. The tibialis anterior muscle studied in 12 volunteers.  Acta Orthop Scand. 1993;  64(3) 377-381
    PubMedGoogle Scholar
  • 6 Tsintzas D, Ghosh S, Maffulli N, King J B, Padhiar N. The effect of ankle position on intracompartmental pressures of the leg [in Turkish].  Acta Orthop Traumatol Turc. 2009;  43(1) 42-48
    CrossrefPubMedGoogle Scholar
  • 7 Rominger M B, Lukosch C J, Bachmann G F. MR imaging of compartment syndrome of the lower leg: a case control study.  Eur Radiol. 2004;  14(8) 1432-1439
    PubMedGoogle Scholar
  • 8 Sievers K W, Högerle S, Olivier L C, Küllmer K, Kisters U. Magnetic resonance tomography evaluation of the lower limb after compartment syndrome [in German].  Unfallchirurgie. 1995;  21(2) 64-69
    CrossrefPubMedGoogle Scholar
  • 9 Katz L M, Nauriyal V, Nagaraj S et al.. Infrared imaging of trauma patients for detection of acute compartment syndrome of the leg.  Crit Care Med. 2008;  36(6) 1756-1761
    CrossrefPubMedGoogle Scholar
  • 10 Edwards Jr P H, Wright M L, Hartman J F. A practical approach for the differential diagnosis of chronic leg pain in the athlete.  Am J Sports Med. 2005;  33(8) 1241-1249
    CrossrefPubMedGoogle Scholar
  • 11 van den Brand J G, Nelson T, Verleisdonk E J, van der Werken C. The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and near-infrared spectroscopy in chronic exertional compartment syndrome: a prospective study in 50 patients.  Am J Sports Med. 2005;  33(5) 699-704
    CrossrefPubMedGoogle Scholar
  • 12 Rorabeck C H, Macnab I. The pathophysiology of the anterior tibial compartmental syndrome.  Clin Orthop Relat Res. 1975;  113(113) 52-57
    CrossrefPubMedGoogle Scholar
  • 13 Edmundsson D, Svensson O, Toolanen G. Intermittent claudication in diabetes mellitus due to chronic exertional compartment syndrome of the leg: an observational study of 17 patients.  Acta Orthop. 2008;  79(4) 534-539
    CrossrefPubMedGoogle Scholar
  • 14 Lauder T D, Stuart M J, Amrami K K, Felmlee J P. Exertional compartment syndrome and the role of magnetic resonance imaging.  Am J Phys Med Rehabil. 2002;  81(4) 315-319
    CrossrefPubMedGoogle Scholar
  • 15 Stiegler H, Brandl R, Krettek C. Chronic relapsing compartment syndrome [in German].  Unfallchirurgie. 2009;  112(4) 373-380
    PubMedGoogle Scholar
  • 16 Gielen J L, Peersman B, Peersman G et al.. Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI.  Skeletal Radiol. 2009;  38(12) 1153-1161
    CrossrefPubMedGoogle Scholar
  • 17 Jawed S, Jawad A S, Padhiar N, Perry J D. Chronic exertional compartment syndrome of the forearms secondary to weight training.  Rheumatology (Oxford). 2001;  40(3) 344-345
    CrossrefPubMedGoogle Scholar
  • 18 Goubier J N, Saillant G. Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases.  Br J Sports Med. 2003;  37(5) 452-453, discussion 453–454
    CrossrefPubMedGoogle Scholar
  • 19 Landi A, Schoenhuber R, Funicello R, Rasio G, Esposito M. Compartment syndrome of the scapula. Definition on clinical, neurophysiological and magnetic resonance data.  Ann Chir Main Memb Super. 1992;  11(5) 383-388
    CrossrefPubMedGoogle Scholar
  • 20 Tarkin I S, Perricelli B C, Pape H C. Exercise induced compartment syndrome of the pectoralis major/deltoid in a professional tree climber.  J Shoulder Elbow Surg. 2009;  18(2) e17-e20
    PubMedGoogle Scholar
  • 21 DiFazio F A, Barth R A, Frymoyer J W. Acute lumbar paraspinal compartment syndrome. A case report.  J Bone Joint Surg Am. 1991;  73(7) 1101-1103
    PubMedGoogle Scholar
  • 22 Lokiec F, Siev-Ner I, Pritsch M. Chronic compartment syndrome of both feet.  J Bone Joint Surg Br. 1991;  73(1) 178-179
    PubMedGoogle Scholar
  • 23 Takebayashi S, Takazawa H, Sasaki R, Miki H, Soh R, Nishimura J. Chronic exertional compartment syndrome in lower legs: localization and follow-up with thallium-201 SPECT imaging.  J Nucl Med. 1997;  38(6) 972-976
    PubMedGoogle Scholar
  • 24 Jeschke J, Baur E M, Piza-Katzer H. Chronic compartment syndrome of the flexor muscles in the forearm due to motocross [in German].  Handchir Mikrochir Plast Chir. 2006;  38(2) 122-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Kumar P R, Jenkins J P, Hodgson S P. Bilateral chronic exertional compartment syndrome of the dorsal part of the forearm: the role of magnetic resonance imaging in diagnosis: a case report.  J Bone Joint Surg Am. 2003;  85-A(8) 1557-1559
    PubMedGoogle Scholar
  • 26 Clanton T O, Solcher B W. Chronic leg pain in the athlete.  Clin Sports Med. 1994;  13(4) 743-759
    PubMedGoogle Scholar
  • 27 Styf J. Diagnosis of exercise-induced pain in the anterior aspect of the lower leg.  Am J Sports Med. 1988;  16(2) 165-169
    CrossrefPubMedGoogle Scholar
  • 28 Milgrom C, Giladi M, Stein M et al.. Medial tibial pain. A prospective study of its cause among military recruits.  Clin Orthop Relat Res. 1986;  (213) 167-171
    PubMedGoogle Scholar
  • 29 Kiuru M J, Mantysaari M J, Pihlajamaki H K, Ahovuo J A. Evaluation of stress-related anterior lower leg pain with magnetic resonance imaging and intracompartmental pressure measurement.  Mil Med. 2003;  168(1) 48-52
    PubMedGoogle Scholar
  • 30 Pedowitz R A, Hargens A R, Mubarak S J, Gershuni D H. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg.  Am J Sports Med. 1990;  18(1) 35-40
    CrossrefPubMedGoogle Scholar
  • 31 Whitesides T E, Haney T C, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy.  Clin Orthop Relat Res. 1975;  113(113) 43-51
    CrossrefPubMedGoogle Scholar
  • 32 Verleisdonk E J, van Gils A, van der Werken C. The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg.  Skeletal Radiol. 2001;  30(6) 321-325
    CrossrefPubMedGoogle Scholar
  • 33 Tzortziou V, Maffulli N, Padhiar N. Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom.  Clin J Sport Med. 2006;  16(3) 209-213
    CrossrefPubMedGoogle Scholar
  • 34 Fleckenstein J L, Canby R C, Parkey R W, Peshock R M. Acute effects of exercise on MR imaging of skeletal muscle in normal volunteers.  AJR Am J Roentgenol. 1988;  151(2) 231-237
    PubMedGoogle Scholar
  • 35 Hayashi M, Hanakawa S, Senda M, Takahara Y. Evaluation of the thigh muscles after knee exercise on a Cybex II.  Acta Med Okayama. 1998;  52(3) 155-160
    PubMedGoogle Scholar
  • 36 Green R A, Wilson D J. A pilot study using magnetic resonance imaging to determine the pattern of muscle group recruitment by rowers with different levels of experience.  Skeletal Radiol. 2000;  29(4) 196-203
    CrossrefPubMedGoogle Scholar
  • 37 Summers R M, Brune A M, Choyke P L et al.. Juvenile idiopathic inflammatory myopathy: exercise-induced changes in muscle at short inversion time inversion-recovery MR imaging.  Radiology. 1998;  209(1) 191-196
    PubMedGoogle Scholar
  • 38 Fisher M J, Meyer R A, Adams G R, Foley J M, Potchen E J. Direct relationship between proton T2 and exercise intensity in skeletal muscle MR images.  Invest Radiol. 1990;  25(5) 480-485
    CrossrefPubMedGoogle Scholar
  • 39 Leppek R, Hoos O, Sattler A et al.. MR-Imaging of lower leg muscle perfusion [in German].  Herz. 2004;  29(1) 32-46
    CrossrefPubMedGoogle Scholar
  • 40 Amendola A, Rorabeck C H, Vellett D, Vezina W, Rutt B, Nott L. The use of magnetic resonance imaging in exertional compartment syndromes.  Am J Sports Med. 1990;  18(1) 29-34
    CrossrefPubMedGoogle Scholar
  • 41 Eskelin M K, Lötjönen J M, Mäntysaari M J. Chronic exertional compartment syndrome: MR imaging at 0.1 T compared with tissue pressure measurement.  Radiology. 1998;  206(2) 333-337
    PubMedGoogle Scholar
  • 42 Litwiller D V, Amrami K K, Dahm D L et al.. Chronic exertional compartment syndrome of the lower extremities: improved screening using a novel dual birdcage coil and in-scanner exercise protocol.  Skeletal Radiol. 2007;  36(11) 1067-1075
    CrossrefPubMedGoogle Scholar
  • 43 Hayes A A, Bower G D, Pitstock K L. Chronic (exertional) compartment syndrome of the legs diagnosed with thallous chloride scintigraphy.  J Nucl Med. 1995;  36(9) 1618-1624
    PubMedGoogle Scholar
  • 44 Trease L, van Every B, Bennell K et al.. A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg.  Eur J Nucl Med. 2001;  28(6) 688-695
    CrossrefPubMedGoogle Scholar
  • 45 Owens S, Edwards P, Miles K, Jenner J, Allen M. Chronic compartment syndrome affecting the lower limb: MIBI perfusion imaging as an alternative to pressure monitoring: two case reports.  Br J Sports Med. 1999;  33(1) 49-51
    CrossrefPubMedGoogle Scholar
  • 46 Edwards P D, Miles K A, Owens S J, Kemp P M, Jenner J R. A new non-invasive test for the detection of compartment syndromes.  Nucl Med Commun. 1999;  20(3) 215-218
    CrossrefPubMedGoogle Scholar
  • 47 Oturai P S, Lorenzen T, Nørregaard J, Simonsen L. Evaluation of Tc-99m-tetrofosmin single-photon emission computed tomography for detection of chronic exertional compartment syndrome of the leg.  Scand J Med Sci Sports. 2006;  16(4) 282-286
    CrossrefPubMedGoogle Scholar
  • 48 Andreisek G, White L M, Sussman M S et al.. T2*-weighted and arterial spin labelling MRI of calf muscles in healthy volunteers and patients with chronic exertional compartment syndrome: preliminary experience.  AJR Am J Roentgenol. 2009;  193 W327-33
    CrossrefPubMedGoogle Scholar
  • 49 Abraham P, Leftheriotis G, Saumet J L. Laser Doppler flowmetry in the diagnosis of chronic compartment syndrome.  J Bone Joint Surg Br. 1998;  80(2) 365-369
    CrossrefPubMedGoogle Scholar
  • 50 Breit G A, Gross J H, Watenpaugh D E, Chance B, Hargens A R. Near-infrared spectroscopy for monitoring of tissue oxygenation of exercising skeletal muscle in a chronic compartment syndrome model.  J Bone Joint Surg Am. 1997;  79(6) 838-843
    Google Scholar
  • 51 Mohler L R, Styf J R, Pedowitz R A, Hargens A R, Gershuni D H. Intramuscular deoxygenation during exercise in patients who have chronic anterior compartment syndrome of the leg.  J Bone Joint Surg Am. 1997;  79(6) 844-849
    CrossrefPubMedGoogle Scholar
  • 52 van den Brand J G, Verleisdonk E J, van der Werken C. Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome.  Am J Sports Med. 2004;  32(2) 452-456
    CrossrefPubMedGoogle Scholar

Philip Bearcroft

Department of Radiology, Box 219

Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ UK

Email: philip.bearcroft@addenbrookes.nhs.uk