Criteria for the diagnosis of chronic compartment syndrome - Clinical investigation of intracompartmental pressure in tibial anterior muscle during muscular activity on the treadmill

Background: The chronic compartment syndrome (CCS) of the musculus tibialis anterior is thought to be responsible for a major part of complaints of th e lower leg among active men. There is an important role of intracompartmen tal pressure (ICP) measurement in diagnosing: CCS. However, there is a cont roversial debate about the relevant parameters. Analysis of literature show s that there has been no standardization concerning the type of muscular ex ertion and measurement technique. There are considerable variations up to 5 00% regarding the recommended parameters. No uniform recommendation for par ameters of diagnostic relevance can be derived. Methods: ICP was measured in 50 patients and 20 probands before, during and after exertion (30 minutes treadmill). The applied measurement technique w as based on the piezoresistive technique (PiCo-Catheter, frequency: 50 Hz). Statistics: Kruskal-Wallis-test. Results: Since there are only slight differences and a distinct interindivi dual variability regarding the pressure values in rest and recovery phase, these parameters are unsuitable. CCS-patients show considerably higher intr acompartmental values of pressure than the control group. Mean values in pr obands increased during the 30-minutes treadmill test from 51.7 mm Hg (Q(25 %)/Q(75%): 42.5/61.8) to 83.4 mm Hg (Q(25%)/Q(75%): 65.5/92.1), in patients from 87.8 mm Hg (Q(25%)/Q(75%): 79.1/108.1) to 116.1 mm Hg (Q(25%)/Q(75%): 108.2/124.3) (p < 0.001). Maximal pressure values in probands from 127.4 m m Hg (Q(25%)/Q(75%): 109.1/156.3) to 186.0 mm Hg (Q(25%)/Q(75%): 159.1/212. 4), in patients from 201.1 mm Hg (Q(25%)/Q(75%): 173.9/227.5) to 249.4 mm H g (Q(25%)/Q(75%): 219.1/291.9) (p < 0.001). Conclusion: Definitive diagnosis of the CCS is based on invasive measuremen t of the ICP in addition to history and physical examination. The recommend ed criterions for diagnosis are unsuitable. Despite highly significant diff erences between patients and probands it doesn't seem appropriate to adjust a criterion of diagnosis only to a fixed value of pressure. It should rath er be combined with the length of time of this pressure.