2005 OITE Question 82

Question

Which of the following compartment pressure measurements best describes chronic exertional compartment syndrome?

1- Resting pressure of 10 mm Hg

2- 15 mm Hg 1 minute postexercise

3- 25 mm Hg 1 minute postexercise

4- 15 mm Hg 5 minutes postexercise

5- 25 mm Hg 5 minutes postexercise

Figures

Answer (click for answer)

The correct answer is 5.

This is a question which requires you to know something about exertional compartment syndrome. Knowing proper baseline resting compartment pressure may be of some help in eliminating answers. Resting pressure is normally < 11 mm Hg, so #1 can be eliminated right off the bat. Chronic exertional compartment syndrome (CECS) is a condition that occurs uncommonly in athletes in which exercise causes compartment pressure to increase to a level that causes significant pain that forces early cessation of activity. Pain and compartment pressure decrease after cessation of activity. The anterior and lateral compartments of the leg are the most commonly affected although any fascial compartment may be involved. It rarely results in the myonecrosis and neurovascular damage seen in acute compartment syndrome unless the difference between diastolic blood pressure and compartment pressure becomes less than 30 mm Hg. It is treated either with activity modification or fasciotomy (frequently endoscopically-assisted to allow small incisions). The pressure criteria used to diagnose CECS are a resting pressure of ? 15 mm Hg, and/or pressure 1 minute after exercise of ? 30 mm Hg, and/or pressure 5 minutes after exercise of ? 20 mm Hg. Under these criteria #5 is the only measurement consistent with CECS.

Reference: RECOMMENDED READINGS: Fraipont MJ, Adamson GJ: Chronic exertional compartment syndrome. J Am Acad Orthop Surg 2003;11:268-276.


Pedowitz RA, Hargens AR, Mubarak SJ, et al: Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 1990;18:35-40.