Intramuscular Deoxygenation during Exercise in Patients Who Have Chronic Anterior Compartment Syndrome of the Leg*
L. RANDALL MOHLER, M.D.†; JORMA R. STYF, M.D., PH.D.‡; ROBERT A. PEDOWITZ, M.D., PH.D.†; ALAN R. HARGENS, PH.D.§; DAVID H. GERSHUNI, M.D.†, SAN DIEGO, CALIFORNIA

Abstract

Currently, the definitive diagnosis of chronic compartment syndrome is based on invasive measurements of intracompartmental pressure. We measured the intramuscular pressure and the relative oxygenation in the anterior compartment of the leg in eighteen patients who were suspected of having chronic compartment syndrome as well as in ten control subjects before, during, and after exercise. Chronic compartment syndrome was considered to be present if the intramuscular pressure was at least fifteen millimeters of mercury (2.00 kilopascals) before exercise, at least thirty millimeters of mercury (4.00 kilopascals) one minute after exercise, or at least twenty millimeters of mercury (2.67 kilopascals) five minutes after exercise. Changes in relative oxygenation were measured with use of the non-invasive method of near-infrared spectroscopy. In all patients and subjects, there was rapid relative deoxygenation after the initiation of exercise, the level of oxygenation remained relatively stable during continued exercise, and there was reoxygenation to a level that exceeded the pre-exercise resting level after the cessation of exercise. During exercise, maximum relative deoxygenation in the patients who had chronic compartment syndrome (mean relative deoxygenation [and standard error], -290 ± 39 millivolts) was significantly greater than that in the patients who did not have chronic compartment syndrome (-190 ± 10 millivolts) and that in the control subjects (-179 ± 14 millivolts) (p < 0.05 for both comparisons). In addition, the interval between the cessation of exercise and the recovery of the pre-exercise resting level of oxygenation was significantly longer for the patients who had chronic compartment syndrome (184 ± 54 seconds) than for the patients who did not have chronic compartment syndrome (39 ± 19 seconds) and the control subjects (33 ± 10 seconds) (p < 0.05 for both comparisons). CLINICAL RELEVANCE: Patients who had chronic anterior compartment syndrome of the leg had greater relative deoxygenation during exercise as well as delayed reoxygenation after exercise; these findings support an ischemic etiology for chronic compartment syndrome. Near-infrared spectroscopy may be useful as a non-invasive diagnostic tool for the evaluation of patients suspected of having chronic anterior compartment syndrome of the leg.

Footnotes

  • *No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding sources were National Aeronautics and Space Administration Grant 199-26-12-34 and the Veterans Administration Medical Center, San Diego, California.

  • Investigation performed at University of California at San Diego, San Diego


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