title: Stiffness and thickness of fascia do not explain chronic exertional compartment syndrome.
abstract: BACKGROUND
  Chronic exertional compartment syndrome is diagnosed based on symptoms and elevated intramuscular pressure and often is treated with fasciotomy. However, what contributes to the increased intramuscular pressure remains unknown.
  
  
  OBJECTIVE
  We investigated whether the stiffness or thickness of the muscle fascia could help explain the raised intramuscular pressure and thus the associated chronic compartment syndrome symptoms.
  
  
  METHODS
  We performed plain radiography, bone scan, and intramuscular pressure measurement to diagnose chronic compartment syndrome and to exclude other disorders. Anterior tibialis muscle fascial biopsy specimens from six healthy individuals, 11 patients with chronic compartment syndrome, and 10 patients with diabetes mellitus and chronic compartment syndrome were obtained. Weight-normalized fascial stiffness was assessed mechanically in a microtensile machine, and fascial thickness was analyzed microscopically.
  
  
  RESULTS
  Mean fascial stiffness did not differ between healthy individuals (0.120 N/mg/mm; SD, 0.77 N/mg/mm), patients with chronic compartment syndrome (0.070 N/mg/mm; SD, 0.052 N/mg/mm), and patients with chronic compartment syndrome and diabetes (0.097 N/mg/mm; SD, 0.073 N/mg/mm). Similarly, no differences in fascial thickness were present. There was a negative correlation between fascial stiffness and intramuscular pressure in the patients with chronic compartment syndrome and diabetes.
  
  
  CONCLUSIONS
  The lack of difference in fascial thickness and stiffness in patients with chronic compartment syndrome and patients with chronic compartment syndrome and diabetes compared with healthy individuals suggests structural and mechanical properties are unlikely to explain chronic compartment syndrome. To prevent chronic exertional compartment syndrome, it is necessary to address aspects other than the muscle fascia.
  
  
  METHODS
  Level II, prognostic study. See the guidelines online for a complete description of level of evidence.
authors.affiliation: Institute of Sports Medicine, Department 8, Bispebjerg Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Dahl
authors.forename: Philip
authors.initials: P
authors.lastname: Hansen
authors.forename: Per
authors.initials: P
authors.lastname: Stål
authors.forename: David
authors.initials: D
authors.lastname: Edmundsson
authors.forename: S Peter
authors.initials: SP
authors.lastname: Magnusson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003161:Compartment Syndromes / Q000453:epidemiology / Q000473:pathology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005205:Fascia / Q000473:pathology*; D000071938:Fasciotomy; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D005082:Physical Exertion; D055815:Young Adult