Concurrent Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome
Abstract
:1. Introduction
2. Case Presentation
2.1. Initial Presentation
2.2. Diagnostic Testing
2.3. Definitive Treatment
3. Discussion
3.1. External Vascular Compression
3.2. Vessel Wall Disease
3.3. Musculoskeletal Overuse
3.4. Nervous System Etiology
3.5. Modalities of Imaging
3.6. Prognosis after Treatment
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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CECS | PAES | |
---|---|---|
Epidemiology | Common (~30%) | Rare (~1%) |
Mechanism | Increased intra-compartmental pressure within a fascial space. | Popliteal artery is compressed by the medial head of the gastrocnemius proximally and the fascial band of the soleus distally during activity. |
Presentation | Exertional leg pain in any of the four compartments of the leg (anterior is most common). Other symptoms include swelling, cramping, and burning symptoms. | Exertional leg pain in the superficial posterior compartment of the leg. Other symptoms include cramping and tenseness in the posterior leg on palpation. |
Laterality | Frequently bilateral. | Unilateral or bilateral. |
Neurologic symptoms | Most commonly, peroneal nerve symptoms, although may have other neurologic compromise. | Rare paresthesias at the sole of the foot. |
Physical Exam | After exercise, the affected compartment will be tender, tense, and painful to passive stretch. | Weaker pulses with the foot in dorsiflexion or plantarflexion and a drop in ankle brachial index of 30–50% with ankle dorsiflexion. |
Diagnosis | Compartment testing > 30 mmHg one minute after ceasing pain-provoking exercises. | CTA, MRA, or diagnostic angiography for confirmation of suspected PAES. |
Treatment | Conservative: physical therapy and massage, trialed for 3 to 6 months. Surgical: for failed conservative treatments, fasciotomy is recommended. | Surgical: open surgical decompression and release of entrapment of the medial head of the gastrocnemius or musculotendinous band. |
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Bellomo, T.R.; Hsu, C.; Bolla, P.; Mohapatra, A.; Kotler, D.H. Concurrent Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome. Diagnostics 2024, 14, 1825. https://doi.org/10.3390/diagnostics14161825
Bellomo TR, Hsu C, Bolla P, Mohapatra A, Kotler DH. Concurrent Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome. Diagnostics. 2024; 14(16):1825. https://doi.org/10.3390/diagnostics14161825
Chicago/Turabian StyleBellomo, Tiffany R., Connie Hsu, Pavan Bolla, Abhisekh Mohapatra, and Dana Helice Kotler. 2024. "Concurrent Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome" Diagnostics 14, no. 16: 1825. https://doi.org/10.3390/diagnostics14161825