Sports Medicine: Just the Facts

•Pain quality described as a tight, cramplike, or squeez-

ing ache over a specific compartment of the leg.

•Paresthesias of the leg or foot with exertion.

• An exercise challenge with detailed physical exami-
  nation immediately after reproduction of symptoms
  will lead to a more judicious use of invasive tech-
  niques (Glorioso and Wilckens, 2001a).

TECHNIQUES TOMEASURECOMPARTMENT
PRESSURES

• Multiple techniques have been described for measur-
  ing both static and dynamic intramuscular pres-
  sures. Techniques include the needle manometer
  (Whitesides et al, 1975), the wick catheter (Mubarak
  et al, 1976), slit catheter (Rorabeck et al, 1981), con-
  tinuous infusion (Matsen et al, 1976), and a solid-state
  transducer intracompartmental catheter (McDermott
  et al, 1982).


• The Stryker Intracompartmental Pressure Monitor
  (Stryker Corporation, Kalamazoo, Michigan) is a bat-
  tery operated, hand-held, digital, fluid pressure moni-
  tor. This device has been found to be more accurate,
  versatile, convenient, and much less time consuming
  in the clinical setting (Hutchinson and Ireland, 1999;
  Awbrey, Sienkiewicz, and Mankin, 1988).

PERFORMANCE OF THEPROCEDURE

• As intracompartmental pressure measurement is an
  invasive procedure, proper technical performance as
  well as patient safety demands a thorough knowledge
  of the anatomy of the leg. Prior to attempting to meas-
  ure compartment pressures, the physician should
  ensure an understanding of the anatomical structures
  in each compartment so as to avoid damage to neu-
  rovascular structures.


• The athlete must be made aware of the indications of
  the procedure, and consent should be obtained and the
  athlete counseled on the risk of infection, scarring,
  damage to nerve and vascular structures, and reaction
  to local anesthesia.
  •Two types of measurements may be obtained during
  the procedure, staticor dynamic.
  
  
  1. Static, or intermittent, pressures are performed
     with a straight needle. Here, intracompartmental
     pressures are determined with a needle stick at rest
     and then again after exertion. The benefits of this
     procedure are that the athlete can perform activity
     causing symptoms without the measuring device
     attached to the leg and without an indwelling
     catheter in the compartment. Also, several com-
     partments can be measured. A negative aspect of
     this technique is that it requires at least two needle
     stick into each compartment being evaluated (one
  
  
  
  

pre- and one postexertion). This procedure is most

commonly used.

2. Dynamic monitoring is performed with the use of a
   slit catheter inserted prior to exertion and
   taped/attached to the athlete’s leg for continuous
   measurements. The benefit of this procedure is that
   the clinician can monitor the pressure changes
   during exertion without halting activity and that
   pressure monitoring during activity may be a more
   precise indicator of pathology (McDermott et al,
   1982). There are several negative aspects of this
   technique. Problems include maintaining the place-
   ment of catheter in the compartment during activity,
   attachment of the system to the athlete, and restric-
   tions of the athlete’s gait as they run to reproduce
   symptoms. The procedure must be performed on a
   treadmill in order to continuously monitor pressure
   changes. Thus, the athlete cannot run outdoors on
   their usual training surface. In addition, only one
   compartment can be measured at a time. Some
   believe that with this technique, the results are
   inconsistent and difficult to obtain and interpret
   (Rorabeck et al, 1988; Rorabeck, Fowler, and Nott,
   1988).
   •With the static technique, measurements should be
   obtained at rest (prior to exertion), immediately after
   (1 min) the reproduction of symptoms, and 5–10 min
   into rest.
   •To properly reproduce symptoms, athletes should per-
   form the specific activity that causes pain/discomfort.

• Three factors may alter the pressure measurements:

1. Proper calibration of the monitor is essential for
   reliable readings. The monitor must be zeroed at
   the same angle that will be used to penetrate the
   skin, and this angle must be maintained with
   repeated sticks.


2. Joint position at both the knee and ankle affect
   pressures (Gershuni et al, 1984).


3. Compression or squeezing the leg can alter pres-
   sures. Externally applied pressure is additive to
   any pressure already existing within the compart-
   ment (Matsen et al, 1976).

• Each compartment should be approached with an
  understanding of the anatomical contents of each
  compartment so as to avoid injury to neurovascular
  structures.

APPROACH TOEACHLEGCOMPARTMENT

• Measurement of intracompartmental pressures is an
  invasive procedure. To avoid damage to neurovascular
  structures, each compartment should be approached
  with an understanding of the anatomical contents
  (Glorioso and Wilckens, 2001a).

132 SECTION 2 • EVALUATION OF THE INJURED ATHLETE