title: Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study.
abstract: BACKGROUND
  Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief.
  
  
  METHODS
  A standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years.
  
  
  RESULTS
  Follow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0±1.5 to 2.3±2.1, P<0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.
  
  
  CONCLUSIONS
  The diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.
authors.forename: Jan Roar
authors.initials: JR
authors.lastname: Orlin
authors.forename: Jarle
authors.initials: J
authors.lastname: Øen
authors.forename: John Roger
authors.initials: JR
authors.lastname: Andersen
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003161:Compartment Syndromes / Q000175:diagnosis / Q000601:surgery*; D005205:Fascia / Q000473:pathology; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement / Q000639:trends*; D017060:Patient Satisfaction; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Curr Rev Musculoskelet Med. 2010 Sep 02;3(1-4):32-7
references.pmid: 21063498
references.citation: Scand J Med Sci Sports. 2012 Oct;22(5):585-95
references.pmid: 22092446
references.citation: Br J Sports Med. 2011 Sep;45(12):952-3
references.pmid: 21616939
references.citation: Clin Orthop Relat Res. 1975 Nov-Dec;(113):69-80
references.pmid: 1192677
references.citation: J Am Acad Orthop Surg. 2003 Jul-Aug;11(4):268-76
references.pmid: 12889865
references.citation: Am J Sports Med. 2005 May;33(5):699-704
references.pmid: 15722275
references.citation: J Hand Surg Am. 1982 May;7(3):252-9
references.pmid: 7086092
references.citation: Acta Orthop. 2008 Aug;79(4):534-9
references.pmid: 18766488
references.citation: Acta Orthop Scand. 1979 Oct;50(5):573-81
references.pmid: 525325
references.citation: Med Care. 2003 May;41(5):582-92
references.pmid: 12719681
references.citation: Acta Orthop. 2007 Feb;78(1):136-42
references.pmid: 17453405
references.citation: Bull Hosp Jt Dis. 2005;62(3-4):77-84
references.pmid: 16022217
references.citation: Clin J Sport Med. 2000 Jul;10(3):176-84
references.pmid: 10959927
references.citation: Br J Sports Med. 2011 Sep;45(12):954-5
references.pmid: 21606173
references.citation: Surgery. 2002 Oct;132(4):613-7; discussion 617-9
references.pmid: 12407344
references.citation: Am J Sports Med. 2002 Jul-Aug;30(4):581-8
references.pmid: 12130414
references.citation: Acta Orthop Scand. 2000 Jun;71(3):262-7
references.pmid: 10919297
references.citation: Am J Sports Med. 1990 Jan-Feb;18(1):35-40
references.pmid: 2301689
references.citation: Scand J Med Sci Sports. 2010 Dec;20(6):805-13
references.pmid: 19804582
references.citation: Clin Orthop Relat Res. 1983 Sep;(178):285-91
references.pmid: 6883862
references.citation: Acta Orthop Scand. 1989 Oct;60(5):593-6
references.pmid: 2603662