Determination of the predictive clinical parameters to diagnose chronic exertional compartment syndrome

Abstract

Chronic exertional compartment syndrome (CECS) is characterized by pain occurring during physical activity. As clinical examination is not sufficient to diagnose it, intracompartmental pressure (ICP) measure is used for CECS confirmation. Numerous clinical signs are reported but their diagnosis predictive ability has never been studied. We aimed to determine if the 12 classically reported clinical signs are predictive of CECS. We performed a single-centre retrospective cohort study on patients referred for CECS suspicion. Patients were asked to run on a treadmill. When pain occurred, post-exercise ICP was performed. We diagnosed CECS if the ICP was ≥30 mmHg and used a logistic regression to calculate the predictive value of clinical signs. One hundred twenty-five patients were evaluated. Ninety-six had CECS and 29 did not, according to the ICP 30 mmHg cut-off. Anterior and lateral compartments were the most frequently affected. After exercise, mean ICP was 58.6 mmHg ± 20.5 in the group with CECS versus 20.9 mmHg ± 4 in the group without (p < .001). Muscle hardness, muscle hernia after exercise, absence of pain at rest and pain recidivism for the same exercise were predictive of CECS. The predictive model associated muscle hardness (Odds Ratio (OR) = 2.18; p < .001) and muscle hernia after exercise (OR = 1.44; p < .001). This model identified 88.6% of CECS subjects. The ROC curve area was 0.808 [95% CI: 0.71-0.90]. This study confirmed the importance of clinical parameters to diagnose CECS. A better knowledge of the relevant parameters could help physicians to indicate invasive examinations.

A Comparison of Two Models Predicting the Presence of Chronic Exertional Compartment Syndrome

“…Superior and inferior cutoffs could be interesting to classify the patients in low, moderate, and high CECS risk categories. The Fouasson-Chailloux et al model combines two strongly specific signs and is very easy to use [13]. The rate of muscle hernia after exercise (40.9 % in the CECS group and 2.3 % in the non-CECS group, p < 0.001) was comparable with other cohorts described in the literature [3,7,38,39].…”

“…The Fouasson-Chailloux et al predictive model had an accuracy of 86 % (▶ table 5) [13]. The sensitivity was 75 % and the specificity was 98 %.…”

“…It highlights the need for an improvement of the diagnostic criteria. Two studies searching for predictive clinical criteria were published in 2017 [12,13].…”

“…Fouasson-Chailloux et al studied the diagnosis predictive ability of 12 classical reported clinical signs in a retrospective cohort [13]. The authors found that muscle hardness, muscle hernia after exercise, absence of pain at rest, and pain recidivism for the same exercise were predictive of CECS.…”

Bilateral simultaneous chronic exertional compartment syndrome of the lateral forefoot: A case report (compartment syndrome of the forefoot)

“…12 Different phenomena seem to be involved: increased muscle bulk, fascia thickness and stiffness, stimulation of fascial sensory stretch-receptors, poor venous return, micromuscular injuries, and small clinical myopathic abnormalities. The most affected compartment is the anterior compartment of the lower leg, 13,14 but there are also case reports and case series describing a chronic exertional compartment syndrome of the foot. [4][5][6][7][8][9] The positive diagnosis is asserted on a body of evidence including:…”