Diagnosis of exercise-induced pain in the anterior aspect of the lower leg

Ninety-eight patients with chronic exercise-induced pain in the anterior compartment of the lower leg underwent extensive clinical and laboratory investigations to establish the diagnosis. They all were referred because of a putative chronic compartment syndrome (CCS). Intramuscular pressure was recorded bilaterally during exercise in the anterior tibial muscle in all of them. Conduction-velocity recordings of the deep and superficial peroneal nerves were performed in 29 patients. Other investigations included radiography, plethysmography, and scintigraphy. CCS was diagnosed in 26 of the 98 patients. Other diagnoses included periostitis in 41 patients, compression of the superficial peroneal nerve in 13, and miscellaneous other diagnoses in 18. CCS seems to be an uncommon reason for anterior pain in the lower legs.     

Intramuscular pressures in exercise-induced lower leg pain

Intramuscular pressures were measured in 12 patients with symptoms of medial tibial syndrome and in 12 patients with chronic anterior compartment syndrome. Measurements were performed with the wick catheter technique simultaneously in the deep posterior and the anterior tibial muscle compartments before, during, and after exercise. In the deep posterior compartment there was no pressure increase during or after exercise as compared to controls in either patient group. However, a significant pressure increase was present in the anterior tibial compartment during and after exercise in the patients with chronic anterior compartment syndrome as compared to normal resting values. The medial tibial syndrome patients demonstrated in the anterior tibial muscle compartment, exercise and post-exercise pressures, which were between those of the healthy controls and the chronic anterior compartment syndrome patients. The so-caLled medial tibial syndrome is probably not a compartment syndrome in the deep posterior muscle compartment. Intramuscular pressure measurement is a valuable tool in diagnosing a chronic compartment syndrome and in selecting patients in whom fasciotomy of the affected compartment is indicated.     

Long-term results of fasciotomy of the anterior compartment in patients with exercise-induced pain in the lower leg

This prospective study aims to describe the results of fasciotomy in patients with exercise-induced pain in the lower leg with suspected (chronic) exertional compartment syndrome. The diagnosis of (chronic) exertional compartment syndrome was made if pain in the lateral side of the lower leg after a standard physical load was accompanied by elevated tissue pressures in the anterior muscle compartment. Tissue measurements were performed in 114 patients. In 56 patients (106 compartments) increased tissue pressure was found (> 50 mmHg measured immediately after exercise, or > 30 mmHg if the pressure before exercise > 20 mmHg, or if the pressure five minutes after exercise is still > 30 mmHg). Two years after fasciotomy, (remaining) complaints were evaluated on the basis of a questionnaire: 87 % of the patients had significant reduction in complaints. Patients who were not found to have increased tissue pressure were also asked to report developments through the questionnaire. In 18 patients a fasciotomy was performed on the basis of the typical history, despite normal or slightly increased intramuscular pressures. Twelve of these patients (24 compartments) were asymptomatic after surgery. Fasciotomy in patients with a (chronic) exercise-induced compartment syndrome in the anterior compartment of the lower leg, based on our criteria, gave a marked reduction in symptoms in 87 % of the patients. Further research has to be done for the minimum tissue pressures above which fasciotomy may be successful in terms of reducing complaints.     

Posteromedial pain in the lower leg

Intramuscular pressure was recorded in 28 patients with exercise-induced posteromedial pain in the lower leg. Pressure was recorded simultaneously in the posterior tibial muscle and in the flexor digitorum muscle during an exercise test and at rest after exercise. This study shows that intramuscular pressures during exercise and the time period for normalization of the pressure at rest after exercise were within normal limits. The result of pressure recording depends on which muscle in the deep posterior compartment is investigated and on the type of work performed. This article describes some of the difficulties associated with pressure recording in the deep posterior compartment. Chronic compartment syndrome in the deep posterior compartment as a reason for pain in the posteromedial part of the lower leg could not be demonstrated.     

Referred pain in the lower leg — A cause of delayed diagnosis

Three patients presenting with ankle pain are described. In each case the pain was referred from a lesion in the proximal tibia (two osteoid osteomas; one stress fracture). There was considerable delay in diagnosis in two of these cases. It would appear that pain referred from the proximal lower leg to the ankle is not well recognized as a clinical entity. In such cases, radiography of the more proximal limb is suggested. If this proves negative, a bone scan may then be performed.     

Diagnostic imaging in athletes with chronic lower leg pain

OBJECTIVE: Our purpose is to describe the imaging features in athletes with chronic lower leg pain, emphasizing the role of MRI and CT, which are the diagnostic tools with the highest sensitivity and specificity in the differential diagnosis of lower leg pain. Moreover, a diagnostic algorithm in patients with chronic lower leg pain is proposed. CONCLUSION: Plain radiography has a low sensitivity but may reveal tibial stress fractures, bone tumors, and soft-tissue calcification. CT and MRI may be useful to better evaluate the abnormalities shown by plain radiography.     

Ankle to brachial pressure index in normal subjects and trained cyclists with exercise-induced leg pain.

PURPOSE: This study compared ankle to brachial pressure indices (ABPI) before and after maximal exercise in three groups in order to investigate maximal exercise testing and ABPI as a useful procedure for the differential diagnosis of exercise-induced leg pain (EILP) in athletes. METHODS: ABPI measurements were taken before and after cycle ergometer exercise to volitional exhaustion or reproduction of symptoms in three groups: 1) untrained individuals (N = 10, 3 female, 7 male; age 35 +/- 5 yr (mean +/- SD)); 2) trained cyclists (N = 10, 3 female, 7 male; age, 30 +/- 5 yr); and 3) symptomatic group of trained cyclists, complaining of EILP (N = 12, 2 female, 10 male; age, 35 +/- 9 yr). RESULTS: Resting blood pressure indices were similar in all groups. ABPI were reduced (P < 0.05) in all groups after exercise. No differences between left and right legs were noted in the elite and untrained groups; however, a significant difference (P < 0.05) was noted between the nonsymptomatic (0.79 +/- 0.10) and symptomatic (0.61 +/- 0.20) legs in the subjects with EILP. Despite these group results, only three subjects in the symptomatic group met the published criteria (index of < 0.5) for endofibrosis of the external iliac artery. All positive ABPI tests were subsequently confirmed via arteriogram. CONCLUSION: Maximal exercise testing combined with ABPI measurement is a simple noninvasive procedure that may be useful for the examination of EILP. The results of this study suggest that, in cases with unilateral symptoms, a between-leg ABPI difference of 0.18 (at the first minute of recovery) may be considered as a useful additional diagnostic criterion.     

Chronic leg pain in athletes due to a recurrent compartment syndrome

A series of 29 patients, all engaged in sports activity on a regular basis, suffering from recurrent compartmental syndrome, is reported. The syndrome is not restricted only to long distance runners but to athletes involved in a variety of sports activities (soccer, volleyball, cycle racing, gymnastics, judo, physical education, and long distance running). Although most patients presented activity-related leg pain, some patients mainly complained of ankle weakness and recurrent ankle distortions at fatigue. The wick catheter technique proved to be most useful to determine which compartments were involved. The severity of clinical symptoms correlated highly with the anomalies of the tissue pressure measurements. The predominance of deep posterior compartment and multiple compartment involvement are in contrast with most previous reports. Conservative treatment was unsuccessful in every patient, whereas surgical decompression of the involved compartments yielded favorable results in those cases where all the involved compartments were released.     

Imaging diagnosis of right lower quadrant pain in children

OBJECTIVE: This article reviews, through clinical case presentation and correlative imaging, a variety of conditions that cause right lower quadrant (RLQ) pain in children. CONCLUSION: This case-based review allows the reader to improve his or her understanding of the differential diagnosis and radiographic appearances of the entities that cause RLQ pain in children.     

Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg

Leg pain in athletes has many aetiologies. The clinician must strive to specifically define the clinical problem in order to administer the appropriate treatment for the athlete's condition. Clinical conditions in the leg causing symptoms in athletes include chronic exertional compartment syndrome (CECC), tendinitis, medial tibial stress syndrome, stress fractures, fascial defects, musculotendinous junction disruptions (tennis leg), popliteal artery entrapment syndrome, effort-induced venous thrombosis and nerve entrapment. Appropriate diagnostic studies are needed to allow accurate diagnosis. A work-up might include radiographs, bone scans and compartment pressure measurement. Many of these conditions relate to overuse and training errors. Conservative measures including rest, activity modification and rehabilitation will permit a gradual return to participation in sports. Some problems such as CECC, popliteal artery entrapment syndrome and nerve entrapment may require surgical intervention to allow the resolution of symptoms. Clinicians should be familiar with the range of problems causing leg pain in order to prescribe specific treatment for each athlete.     

Glomangiomatosis of the lower leg

This paper demonstrates a case of multiple glomangiomas, or glomangiomatosis, including clinical presentation, imaging appearances, and subsequent management. Differentiating features from typical glomus tumors are described. To the best of our knowledge, this is the first reported case of a glomangioma involving the distal tibiofibular syndesmosis.     

A practical approach for the differential diagnosis of chronic leg pain in the athlete

Chronic lower leg pain results from various conditions, most commonly, medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome. Symptoms associated with these conditions often overlap, making a definitive diagnosis difficult. As a result, an algorithmic approach was created to aid in the evaluation of patients with complaints of lower leg pain and to assist in defining a diagnosis by providing recommended diagnostic studies for each condition. A comprehensive physical examination is imperative to confirm a diagnosis and should begin with an inquiry regarding the location and onset of the patient's pain and tenderness. Confirmation of the diagnosis requires performing the appropriate diagnostic studies, including radiographs, bone scans, magnetic resonance imaging, magnetic resonance angiography, compartmental pressure measurements, and arteriograms. Although most conditions causing lower leg pain are treated successfully with nonsurgical management, some syndromes, such as popliteal artery entrapment syndrome, may require surgical intervention. Regardless of the form of treatment, return to activity must be gradual and individualized for each patient to prevent future athletic injury.     

彩色多普勒超声在急性孤立性小腿深静脉血栓中应用价值

目的探讨彩色多普勒超声在急性孤立性小腿深静脉血栓诊断中的临床应用价值。方法选取2016年1-12月收治的急性下肢深静脉主干血栓患者38例作为A组,急性孤立性小腿深静脉血栓患者38例作为B组。两组患者均给予彩色多普勒超声检查,比较两组超声诊断准确率。结果两组超声诊断准确率均较高,差异无统计学意义(P>0.05)。结论应用彩色多普勒超声诊断急性孤立性小腿深静脉血栓准确率高,值得在临床检查诊断工作中推广应用。