Compartment Pressure Testing for CECS
Compartment Pressure Testing (CPT)
for
Chronic Exertional Compartment Syndrome (CECS)
Q1: What is Compartment Pressure Testing?
- This is a diagnostic procedure whereby the pressures in one or more of the muscle compartments (often the anterior or deep posterior compartments of the lower legs; or the volar or dorsal compartments in the forearm) are tested with a needle attached to an intracompartmental pressure monitor.
- The aim is to diagnose or exclude the medical condition known as Chronic Exertional Compartment Syndrome (CECS). There are various ways of performing this and the interpretation of results can be challenging. An abnormal result does not always equate to CECS!
- Lower limb CECS is a known cause of exercise-induced leg pain (EILP). EILP typically occurs in sports which involve running, marching or jumping and there are multiple causes.
- Compartment Pressure Testing is more frequently performed for issues arising from the lower limb but can also be carried out for issues in the upper limb (forearm & wrist) too. For that reason, many of the questions and answers below will focus more on the lower limb but the general principles of preparation and testing are similar.
Q2: What preparation is required?
- An initial clinic appointment occurs where Dr Seah will take a detailed medical history and examine you to consider all causes of exercise-induced leg pain (these include musculoskeletal, vascular and neurological causes). This consultation is required as patients with known severe clotting disorders, on anticoagulation medication, have metalwork from previous surgery to the area or are generally unwell may not be suitable to have this procedure performed. Your safety is paramount!
- As part of that initial clinic work-up, he may need to organise imaging investigations (such as X-rays, Ultrasound, MRI or CT scans) or blood tests if indicated. Please bring along relevant prior clinic letters, blood test results, imaging reports and images for your initial clinic appointment with Dr Seah.
- If Dr Seah agrees you are suitable to have compartment pressure testing, he will proceed to consent you and explain what is involved in the procedure. This procedure may occur on the same day or be performed on a separate day- each case is different and varies according to what further information and preparation is necessary. Although he will try to accommodate, please understand It is not alway possible to predict if the procedure can be done on the same day or needs to be postponed.
- You should attempt to go for several runs over a few days before you have the procedure done- this increases the likelihood of being able to reproduce your actual symptoms consistently on the day of testing, making the test results more accurate.
- If the trigger for your pain involves something other than running, then please try to perform that action several times over a few days to reliably reproduce your symptoms on the day of testing.
- If your symptoms require the use of equipment or tools (for example, the repeated use of a screwdriver pushing a metal nail into a piece of wood in patients with forearm symptoms, then please bring along all pieces of the kit or equipment to do the test, if feasible). It is absolutely essential that we try to accurately reproduce the symptoms that trouble you before doing the test!
Q3: What does the procedure involve?
- Following an informed discussion, you will be asked to sign a written consent form.
- CECS testing is carried out using a handheld intracompartmental pressure monitoring system. This involves a small needle catheter inserted into the selected lower leg (or upper limb) muscle compartments under local anaesthesia and sterile conditions. Pressure measurements will be taken and a high pressure reading can be suggestive of CECS. Pressure measurements may be taken at rest and immediately after exertion.
- During the procedure, you will be asked to run on a treadmill in order to reproduce the symptoms of leg pain/ weakness / numbness that you may experience regularly on exercise. If the trigger for your symptoms are different, then the test may be modified with this in mind.
- You must bring your own running attire (running shorts only, not full length leggings or tracksuit bottoms), running shoes and gym towel for this test.
- Ensure you have eaten and drank clear fluids beforehand.
- Ensure you are also well rested before the test as you may be asked to run very vigorously on the treadmill in order to accurately reproduce your leg symptoms.
Q4: What happens after you have had the procedure?
- Firm pressure and a clean dressing will be applied over the site of injection. Your results will be discussed with you after the procedure. Dr Seah will write back to the referrer with the results to keep them informed.
Q5: Are there any risks?
- This is generally a safe procedure. You may experience some bruising at the sites where the needle has been injected.
- Care is taken to do this under aseptic (clean) conditions but there is a very small risk of infection (less than 0.01%) where the cannula is inserted. If you should experience severe pain, fever or swelling in the days after the procedure, you should contact your doctor or attend the emergency department outside of normal working hours to have it checked.
- There is a very small chance of getting an acute compartment syndrome (less than 0.01%) if one of the blood vessels in your legs is damaged during the procedure. If you develop severe pain and swelling within 24 hours of the procedure, you should attend emergency department to have it checked. Incidentally, the treatment for this is the same operation (surgical release of the affected compartment) as CECS.
- During the Covid-19 pandemic and lockdown, additional safety precautions will be applied to ensure the safety of the patient and clinic staff throughout the testing procedure. These precautions will be explained to you in detail during the initial consultation.
Q6: Should I rest after the procedure?
- There is no specific need to rest after the procedure. Hydrate well.
- You can return to gentle exercise the following day but please avoid strenuous exercise or impact (e.g. sprinting, aerobics) for 48 hours after the procedure.
- Oral painkillers can be helpful if you are sore after the procedure. This soreness often settles quickly- within a few hours to a few days.
Expertise
- Dr Seah has undergone formal instruction and training in performing Compartment Pressure Testing at various stages of his postgraduate training (between 2005-2011) at the Olympic Medical Institute, Charing Cross Hospital, Queen Mary University of London, Royal National Orthopaedic Hospital and the Defence Medical Rehabilitation Centre. He has been performing these tests independently since 2011.
Bibliography
- Vogels S, Ritchie ED, van Dongen TTCF, Scheltinga MRM, Zimmermann WO, Hoencamp R. Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg. Scand J Med Sci Sports. 2020; 30: 1827-1845.
- Ding A, Machin M, Onida S, Davies AH. A systematic review of fasciotomy in chronic exertional compartment syndrome. Journal of Vascular Surgery. 2020; 72(5), 1802-1812.
- Velasco TO, Leggit JC. Chronic Exertional Compartment Syndrome: A Clinical Update. Current Sports Medicine Reports. 2020; 19(9), 347-352.
- Hutchinson M. Chronic exertional compartment syndrome. BJSM 2011; 45: 952-953.
- Bong MR, Polatsch DB, Jazrawi LM, Rokito AS. Chronic exertional compartment syndrome: diagnosis and management. Bulletin of the NYU Hospital for Joint Diseases. 2005; 62(3-4), 77.
