Chronic exertional compartment syndrome (CECS) is an exercise-induced condition, in which high pressure develops in one or several lower leg compartments, resulting in pain, numbness, and temporary muscle paresis. Diagnosis of CECS is assisted by measurements of intracompartment pressures (ICP) at rest, 1-min and 5-min after cessation of running exercise (Pedowitz criteria). ICP is measured via needle manometry, which is an invasive procedure. We have recently shown that intramuscular pressure is correlated to shear modulus measured via shear wave elastography (SWE) (Spearman's correlation coefficient = 0.99). The objectives of this study were to quantify temporal changes in shear modulus of muscle in lower leg compartments of healthy individuals before and after running exercise, and to evaluate a Pedowitz-like criterion for diagnosis of CECS using muscle shear modulus as biomarker. Specifically, the shear modulus of the tibialis anterior (TA) and peroneus longus (PL) was measured at time intervals of 1 min for 10 min after cessation of exercise. The shear modulus of the TA, PL, Soleus and Tibialis posterior were also measured bilaterally before, and at 1- and 5-min after exercise in a procedure that resembles the Pedowitz test for ICP. The shear modulus of all compartments increased significantly in both legs 1-min postexercise and gradually decreased to prerunning values. 50% of such decrease occurred at between 3 and 5 min after cessation of exercise. Additionally, the change in shear modulus followed a similar pattern than ICP in the Pedowitz-like protocol. Therefore, SWE has the potential to diagnose CECS noninvasively.

References

References
1.
Schubert
,
A. G.
,
2011
, “
Exertional Compartment Syndrome: Review of the Literature and Proposed Rehabilitation Guidelines Following Surgical Release
,”
Int. J. Sports Phys. Ther.
,
6
(
2
), pp.
126
141
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109896/
2.
Detmer
,
D. E.
,
Sharpe
,
K.
,
Sufit
,
R. L.
, and
Girdley
,
F. M.
,
1985
, “
Chronic Compartment Syndrome: Diagnosis, Management, and Outcomes
,”
Am. J. Sports Med.
,
13
(
3
), pp.
162
170
.
3.
Blackman
,
P. G.
,
2000
, “
A Review of Chronic Exertional Compartment Syndrome in the Lower Leg
,”
Med. Sci. Sports Exerc.
,
32
(
3 Suppl
.), pp.
S4
S10
.
4.
Pedowitz
,
R. A.
,
Hargens
,
A. R.
,
Mubarak
,
S. J.
, and
Gershuni
,
D. H.
,
1990
, “
Modified Criteria for the Objective Diagnosis of Chronic Compartment Syndrome of the Leg
,”
Am. J. Sports Med.
,
18
(
1
), pp.
35
40
.
5.
Tucker
,
A. K.
,
2010
, “
Chronic Exertional Compartment Syndrome of the Leg
,”
Curr. Rev. Musculoskeletal Med.
,
3
(
1–4
), pp.
32
37
.
6.
Van Den Brand
,
J. G.
,
Nelson
,
T.
,
Verleisdonk
,
E. J.
, and
Van Der Werken
,
C.
,
2005
, “
The Diagnostic Value of Intracompartmental Pressure Measurement, Magnetic Resonance Imaging, and Near-Infrared Spectroscopy in Chronic Exertional Compartment Syndrome: A Prospective Study in 50 Patients
,”
Am. J. Sports Med.
,
33
(
5
), pp.
699
704
.
7.
Wilder
,
R. P.
, and
Sethi
,
S.
,
2004
, “
Overuse Injuries: Tendinopathies, Stress Fractures, Compartment Syndrome, and Shin Splints
,”
Clin. Sports. Med.
,
23
(
1
), pp.
55
81
.
8.
Ulmer
,
T.
,
2002
, “
The Clinical Diagnosis of Compartment Syndrome of the Lower Leg: Are Clinical Findings Predictive of the Disorder?
,”
J. Orthop. Trauma
,
16
(
8
), pp.
572
577
.
9.
Sadeghi
,
S.
,
Johnson
,
M.
,
Bader
,
D. A.
, and
Cortes
,
D. H.
,
2019
, “
The Shear Modulus of Lower-Leg Muscles Correlates to Intramuscular Pressure
,”
J. Biomech.
,
83
, pp.
190
196
.
10.
Hislop
,
M.
, and
Tierney
,
P.
,
2011
, “
Intracompartmental Pressure Testing: Results of an International Survey of Current Clinical Practice, Highlighting the Need for Standardised Protocols
,”
Br. J. Sports Med.
,
45
(
12
), pp.
956
958
.
11.
Mohler
,
L. R.
,
Styf
,
J. R.
,
Pedowitz
,
R. A.
,
Hargens
,
A. R.
, and
Gershuni
,
D. H.
,
1997
, “
Intramuscular Deoxygenation During Exercise in Patients Who Have Chronic Anterior Compartment Syndrome of the Leg
,”
JBJS
,
79
(
6
), pp.
844
849
.
12.
van den Brand
,
J. G.
,
Verleisdonk
,
E. J.
, and
van der Werken
,
C.
,
2004
, “
Near Infrared Spectroscopy in the Diagnosis of Chronic Exertional Compartment Syndrome
,”
Am. J. Sports Med.
,
32
(
2
), pp.
452
456
.
13.
Giannotti
,
G.
,
Cohn
,
S. M.
,
Brown
,
M.
,
Varela
,
J. E.
,
McKenney
,
M. G.
, and
Wiseberg
,
J. A.
,
2000
, “
Utility of Near-Infrared Spectroscopy in the Diagnosis of Lower Extremity Compartment Syndrome
,”
J. Trauma Acute Care Surg.
,
48
(
3
), pp.
396
401
.
14.
Lauder
,
T. D.
,
Stuart
,
M. J.
,
Amrami
,
K. K.
, and
Felmlee
,
J. P.
,
2002
, “
Exertional Compartment Syndrome and the Role of Magnetic Resonance Imaging
,”
Am. J. Phys. Med. Rehab.
,
81
(
4
), pp.
315
319
.
15.
Verleisdonk
,
E.
,
Van Gils
,
A.
, and
Van der Werken
,
C.
,
2001
, “
The Diagnostic Value of MRI Scans for the Diagnosis of Chronic Exertional Compartment Syndrome of the Lower Leg
,”
Skeletal Radiol.
,
30
(
6
), pp.
321
325
.
16.
Amendola
,
A.
,
Rorabeck
,
C.
,
Vellett
,
D.
,
Vezina
,
W.
,
Rutt
,
B.
, and
Nott
,
L.
,
1990
, “
The Use of Magnetic Resonance Imaging in Exertional Compartment Syndromes
,”
Am. J. Sports Med.
,
18
(
1
), pp.
29
34
.
17.
Wiemann
,
J. M.
,
Ueno
,
T.
,
Leek
,
B. T.
,
Yost
,
W. T.
,
Schwartz
,
A. K.
, and
Hargens
,
A. R.
,
2006
, “
Noninvasive Measurements of Intramuscular Pressure Using Pulsed Phase-Locked Loop Ultrasound for Detecting Compartment Syndromes: A Preliminary Report
,”
J. Orthop. Trauma.
,
20
(
7
), pp.
458
463
.
18.
Garabekyan
,
T.
,
Murphey
,
G. C.
,
Macias
,
B. R.
,
Lynch
,
J. E.
, and
Hargens
,
A. R.
,
2009
, “
New Non-Invasive Ultrasound Technique for Monitoring Perfusion Pressure in a Porcine Model of Acute Compartment Syndrome
,”
J. Orthop. Trauma.
,
23
(
3
), p.
186
.
19.
Birtles
,
D.
,
Rayson
,
M.
,
Jones
,
D.
,
Padhiar
,
N.
,
Casey
,
A.
, and
Newham
,
D.
,
2003
, “
Effect of Eccentric Exercise on Patients With Chronic Exertional Compartment Syndrome
,”
Eur. J. Appl. Physiol.
,
88
(
6
), pp.
565
571
.
20.
Casey
,
D. P.
,
Curry
,
T. B.
, and
Joyner
,
M. J.
,
2008
, “
Measuring Muscle Blood Flow a Key Link Between Systemic and Regional Metabolism
,”
Curr. Opin. Clin. Nutr. Metab. Care.
,
11
(
5
), p.
580
.
21.
Bercoff
,
J.
,
Tanter
,
M.
, and
Fink
,
M.
,
2004
, “
Supersonic Shear Imaging: A New Technique for Soft Tissue Elasticity Mapping
,”
IEEE Trans. Ultrason. Ferr.
,
51
(
4
), pp.
396
409
.
22.
Cortes
,
D. H.
,
Suydam
,
S. M.
,
Silbernagel
,
K. G.
,
Buchanan
,
T. S.
, and
Elliott
,
D. M.
,
2015
, “
Continuous Shear Wave Elastography: A New Method to Measure Viscoelastic Properties of Tendons In Vivo
,”
Ultrasound Med. Biol.
,
41
(
6
), pp.
1518
1529
.
23.
Palmeri
,
M. L.
, and
Nightingale
,
K. R.
,
2011
, “
Acoustic Radiation Force-Based Elasticity Imaging Methods
,”
Interface Focus
,
1
(
4
), pp.
553
564
.
24.
Brandenburg
,
J. E.
,
Eby
,
S. F.
,
Song
,
P.
,
Zhao
,
H.
,
Landry
,
B. W.
,
Kingsley-Berg
,
S.
,
Bamlet
,
W. R.
,
Chen
,
S.
,
Sieck
,
G. C.
, and
An
,
K.-N.
,
2015
, “
Feasibility and Reliability of Quantifying Passive Muscle Stiffness in Young Children by Using Shear Wave Ultrasound Elastography
,”
J. Ultrasound Med.
,
34
(
4
), pp.
663
670
.
25.
Lacourpaille
,
L.
,
Hug
,
F.
,
Bouillard
,
K.
,
Hogrel
,
J.-Y.
, and
Nordez
,
A.
,
2012
, “
Supersonic Shear Imaging Provides a Reliable Measurement of Resting Muscle Shear Elastic Modulus
,”
Physiol. Meas.
,
33
(
3
), p.
N19
.
26.
Sadeghi
,
S.
,
Newman
,
C.
, and
Cortes
,
D. H.
,
2018
, “
Change in Skeletal Muscle Stiffness After Running Competition Is Dependent on Both Running Distance and Recovery Time: A Pilot Study
,”
PeerJ
,
6
, p.
e4469
.
27.
Lin
,
C.-Y.
,
Sadeghi
,
S.
,
Bader
,
D. A.
, and
Cortes
,
D. H.
,
2017
, “
Ultrasound Shear Wave Elastography of the Elbow Ulnar Collateral Ligament: Reliability Test and a Preliminary Case Study in a Baseball Pitcher
,”
ASME J. Eng. Sci. Med. Diagn. Ther.
,
1
(
1
), p.
011004
.
28.
Davis
,
D. E.
,
Raikin
,
S.
,
Garras
,
D. N.
,
Vitanzo
,
P.
,
Labrador
,
H.
, and
Espandar
,
R.
,
2013
, “
Characteristics of Patients With Chronic Exertional Compartment Syndrome
,”
Foot Ankle Int.
,
34
(
10
), pp.
1349
1354
.
29.
Raikin
,
S. M.
,
Rapuri
,
V. R.
, and
Vitanzo
,
P.
,
2005
, “
Bilateral Simultaneous Fasciotomy for Chronic Exertional Compartment Syndrome
,”
Foot Ankle Int.
,
26
(
12
), pp.
1007
1011
.
30.
Baltopoulos
,
P.
,
Papadakou
,
E.
,
Tsironi
,
M.
,
Karagounis
,
P.
, and
Prionas
,
G.
,
2008
, “
Pre, During, and Post Exercise Anterior Tibial Compartment Pressures in Long Distance Runners
,”
J. Sports Sci. Med.
,
7
(
1
), p.
96
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763359/
31.
Barrera-Ochoa
,
S.
,
Correa-Vazquez
,
E.
,
Gallardo-Calero
,
I.
,
Haddad
,
S.
,
Sallent
,
A.
,
Soldado
,
F.
,
Campillo-Recio
,
D.
, and
Mir-Bullo
,
X.
,
2018
, “
TRest as a New Diagnostic Variable for Chronic Exertional Compartment Syndrome of the Forearm: A Prospective Cohort Analysis of 124 Athletes
,”
Clin. J. Sport Med.
,
28
(
6
), pp.
516
523
.
32.
Hicks
,
A. L.
,
Kent-Braun
,
J.
, and
Ditor
,
D. S.
,
2001
, “
Sex Differences in Human Skeletal Muscle Fatigue
,”
Exerc. Sport Sci. Rev.
,
29
(
3
), pp.
109
112
.
33.
Häkkinen
,
K.
,
1993
, “
Neuromuscular Fatigue and Recovery in Male and Female Athletes During Heavy Resistance Exercise
,”
Int. J. Sports Med.
,
14
(
02
), pp.
53
59
.
You do not currently have access to this content.