title: The amplitude of pulse-synchronous oscillations varies with the level of intramuscular pressure in simulated compartment syndrome.
abstract: BACKGROUND
  Patients with compartment syndromes have elevated intramuscular pressure (IMP) due to increased volume in the affected muscle. However, the accuracy of IMP as a parameter in diagnosing chronic compartment syndrome has been questioned. It has been observed that arterial pulsations create oscillations in the IMP in patients with abnormally elevated IMP. The amplitude of the IMP oscillations appears to be related to a pathogenic mechanism of elevated IMP. Therefore, the purpose of the present study was to investigate the relation between the amplitude of pulse-synchronous IMP oscillations and the absolute level of IMP with a high-end fiber-optic system in a human experimental model of abnormally elevated IMP (simulated compartment syndrome) of the leg. The hypothesis that the amplitude of the IMP oscillations is correlated to the absolute level of IMP was tested.
  
  
  METHODS
  IMP was measured at rest in the anterior tibial muscle in 12 legs of 7 healthy subjects (4 females and 3 males) with a mean age of 28 (range 23-38) years. The subject lay supine with his/her heel placed in a footrest. The foot was kept in a neutral position to avoid biased IMP readings. Measurements were performed at baseline and during 10 minutes with a model of abnormally elevated IMP (simulated compartment syndrome) applied. The abnormally elevated IMP was created by venous obstruction induced by a thigh tourniquet (65 mmHg) of a casted leg. Placement of the pressure-recording catheter was verified by sonography.
  
  
  RESULTS
  The IMP increased from 4.7 (SD = 1.8) mmHg at baseline to 48.6 (SD = 7.1) mmHg when the model of elevated IMP was applied. The amplitude of the pulse-synchronous oscillations was undetectable at baseline. It increased to 3.9 (SD = 1.4) mmHg with increasing IMP when the model was applied. The amplitude of the oscillations showed a positive correlation (r = 0.59) with the absolute level of IMP.
  
  
  CONCLUSIONS
  The amplitude of the pulse-synchronous IMP oscillations is correlated with the absolute level of IMP during abnormally elevated IMP. The oscillations of IMP may therefore be an additional parameter assuring the abnormally elevated IMP in the diagnosis of compartment syndromes.
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Guldhedsgatan 10 A, 413 46, Gothenburg, Sweden. andreas.nilsson@orthop.gu.se.
authors.forename: Andreas
authors.initials: A
authors.lastname: Nilsson
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Guldhedsgatan 10 A, 413 46, Gothenburg, Sweden. qiuxia.zhang@orthop.gu.se.|Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden. qiuxia.zhang@orthop.gu.se.
authors.forename: Qiuxia
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Guldhedsgatan 10 A, 413 46, Gothenburg, Sweden. jorma.styf@orthop.gu.se.|Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden. jorma.styf@orthop.gu.se.
authors.forename: Jorma
authors.initials: J
authors.lastname: Styf
keywords: Compartment syndrome; Fiber-optic technique; Intramuscular arterial pulsations; Intramuscular pressure; Pulse-synchronous oscillations in intracompartmental pressure