![]() There is a statistically significant increase of T2-weighted signal intensity in the extensor compartment during exercise in patients with chronic compartment syndrome in comparison with the control group. MR has already proven to be useful in the setting of chronic exertional compartment syndrome. The T2-weighted signal intensity of muscle increases during exercise, due to the higher water content. Second, MR is an even better modality for soft-tissue evaluation, including muscle. Besides, it is also a fast and reliable test to exclude other causes of acute lower extremity pain. First, although increased reflectivity and swelling of the muscles on ultrasound are nonspecific findings, they indicate muscle edema, as seen in compartment syndrome. Pressure measurements can be additionally performed, with normal pressures ranging between 0 and 15 mmHg. Recognizing the clinical signs of compartment syndrome is crucial for diagnosis, regardless of the underlying cause. The fiber swelling and increased compartmental blood volume initiate a vicious cycle: the elevated compartmental pressure hampers muscle perfusion, and the edema secondary to the subsequent myoneural ischemia increases the compartmental pressure even further, eventually resulting in muscle necrosis. It states that strenuous eccentric exercise and the resulting myofiber damage cause the release of protein-bound ions, which increase the osmotic pressure in the compartment. The pathophysiology of exertional compartment syndrome is known in the literature as the mechanical damage theory. The more rare, acute form of exertional compartment syndrome was first introduced as ‘march gangrene’ in 1945 by Vogt. This etiology is well known and studied.Ĭompartment syndrome can also be caused by vigorous exercise and mostly manifests in a chronic form, with symptoms spontaneously resolving after rest. Īcute trauma is the most frequent cause of acute compartment syndrome. Compartment syndrome occurs when the interstitial pressure rises above the diastolic blood pressure, and as a result capillary perfusion is compromised. Rapid volume increase in a compartment inevitably results in increased pressure in this compartment. The lower leg consists of four compartments: an anterior (extensor), a lateral (peroneal), a superficial posterior, and a deep posterior (flexor) muscle compartment, each of them enclosed by a firm fascia and separated by either the interosseous membrane or an intermuscular septum. However, swelling and increased echogenicity of the peroneus longus and brevis muscles were apparent (Figure 1). On imaging, the nerve demonstrated a normal caliber and echotexture, without extrinsic compression by a discrete mass or fluid collection. He then developed a drop foot, and a second ultrasound exam was ordered to evaluate the common peroneal nerve. However, the patient’s overall temperature was normal, and he showed no signs of systemic illness. Over the next few days, all clinical findings and the pain increased, and the lateral lower leg became swollen. In combination with redness and elevated temperature of the overlying skin, the imaging findings were interpreted as infectious cellulitis. No trauma occurred during the game.Īn ultrasound exam of the lower leg was ordered, which showed extensive subcutaneous edema. The pain started shortly after playing a soccer game in competition. A 21-year old male patient presented to the emergency department with pain in the lateral aspect of his left lower leg.
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