Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study

Abstract

BackgroundIntracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief.MethodsA standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years.ResultsFollow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0 ± 1.5 to 2.3 ± 2.1, P < 0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.ConclusionsThe diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.

Leg cramps in pregnancy caused by chronic compartment syndrome and relieved by fasciotomy after childbirth

“…Clinically, one needs to discriminate the pain in the anterior part of the leg caused by irritation of a L5‐nerve root from the pain caused by an anterior CCS and correspondingly by the other compartments. Recently clinical examination proved more adequate than pressure measurement in deciding how many compartments need fasciotomy in order to achieve permanent pain free legs . The technique of fasciotomy of all four leg compartments, paralleling the general recommendation in acute cases, was adapted toward modern endoscopic principles in order to evade disturbing scars whilst trying not to damage local nerves (Fig.…”

“…) and a VAS pain score, commenting spontaneously that 120% pain was more like hers (a patient with less than 50% VAS pain score is usually not in need of surgery). Upon palpation of her legs, tenderness seemed excessive in all muscle compartments, perhaps maximal in the lateral compartments, increasing in all during an exertional step test . Arterial pulse was normal both in the groins, in the ankles, and in the feet.…”

The collateral benefits of having chiropractic available in a public central hospital

“…The recognition of her signs and symptoms indicated chronic compartment syndrome of the legs and all tests were positive [8] . A recent MRI scan of her lumbar spinal canal revealed normal findings and she was referred to the orthopedic department for further examination and surgery [8] .…”

“…In the lower extremity, leg pain and cramps seem to accompany chronic compartment syndrome [8] , affecting nerves in the foot and leg compartments as well as in the tarsal tunnels. Due to the close working conditions in the region, both chiropractors and medical doctors are learning to recognize and refer these conditions to the orthopedic department, despite its apparent biomechanical presentation.…”

“…A recent MRI scan of her lumbar spinal canal revealed normal findings and she was referred to the orthopedic department for further examination and surgery [8] . Upon revisiting the chiropractic clinic three months later, her right leg had been operated on and she was waiting for the same procedure to be performed in the other leg.…”