Intracompartmental pressure testing: results of an international survey of current clinical practice, highlighting the need for standardised protocols

Abstract

Despite more recent non-invasive modalities generating some credence in the literature, intracompartmental pressure testing is still considered the 'gold standard' for investigating chronic exertional compartment syndrome (CECS). Intracompartmental pressure testing, when used correctly, has been shown to be accurate and reliable. However, it is a user-dependent investigation, and the manner in which the investigation is conducted plays a large role in the outcome of the test. Despite this, a standard, reproducible protocol for intracompartmental pressure testing has not been described. This results in confusion regarding interpretation of results and reduces the tests' reliability. A summary of the current understanding of CECS is presented, along with the results of a survey of specialists in Australia and New Zealand who perform intracompartmental pressure testing, which confirms that a uniform approach is currently not used in clinical practice. This highlights the need for a consensus and standardised approach to intracompartmental pressure testing.

Ultrasound‐Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg

“…3 The technique for measuring intracompartmental pres- sures using the Stryker system is well accepted in the literature, 1,14 as are the "pressure cutoff points" in the criteria of Pedowitz et al 11 However, there is some variability in the measurement protocols. 1,[15][16][17] In our study, we choose to provoke the symptoms by means of continuous running on a treadmill (up to 25 minutes). To accomplish this provocation, it is important to perform the study in a highperformance sports medicine department where the pressure measurements can be done next to the treadmill.…”

Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery

“…5 The classic diagnostic feature is an elevation of the compartment pressure following exercise, with description of a number of pressure measurement techniques including needle manometry, a wick catheter, a slit catheter, or a constant infusion catheter, [6][7][8][9] although there is no universally accepted pressure measurement protocol. 10 Management may be conservative or surgical with surgery being considered the treatment of choice for patients wishing to restore their pre-CECS activity level. [11][12][13][14][15] Review of the available medical literature reveals no comparative studies of surgical therapy versus conservative treatment in CECS of the lower leg.…”

Role of Repeat Muscle Compartment Pressure Measurements in Chronic Exertional Compartment Syndrome of the Lower Leg

“…27 However, a correlation between these cutoff values and treatment outcomes has never been demonstrated, fueling a discussion regarding its absolute role in the diagnostic process as well as its prognostic value. 5,17,29 Moreover, ICP pressure catheters may be positioned suboptimally when introduced using a “blind” technique, especially in the deep posterior compartment. 40 It is therefore not a surprise that fasciotomy after a positive ICP test does not always confer success.…”