Clinical Problem

Problem Statement

Due to the time sensitivity, user-dependence, and extreme physical discomfort associated with diagnosing chronic exertional compartment syndrome (CECS) using intracompartmental pressure testing, sports medicine physicians and people who are undergoing compartment pressure testing need a less painful, non-invasive, and more efficient diagnostic method.

Disease background: Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome is a pathological condition characterized by increased pressure in one or more compartments of the lower leg, usually in response to swelling or injury of the muscle tissue (OrthoInfo). Compartments are groups of muscles, nerves, and blood vessels surrounded by fascia. Fascia, a tough collagenous membrane, does not stretch, and this lack of elasticity causes the increased pressure in the compartment when the swelling occurs. The high pressure can disrupt blood flow to the muscles and nerve cells, which can cause them damage due to prolonged lack of oxygen and nutrients.

Figure 1: Diagram of compartments in lower leg (MayoClinic)

Diagnostic Method: Intracompartmental needle manometry

  • Procedure involves inserting a needle into compartment, injecting saline solution, and measuring pressure created by resistance of muscle against the injected solution before and after exercise (MayoClinic). Affected compartments experience elevated post-exercise pressure levels because the fascia restrict muscle expansion.

  • Devices used:

    • Compass Compartment Pressure Monitoring Kit: one-time use product that digitally displays the pressure measurement

    • Stryker Pressure Monitor System: uses replaceable syringe implementation

Problems with Intracompartmental needle manometry

    • Extremely painful: inject each compartment in each leg before and after exercise with a 16-18 gauge needle without use of local anesthetics

    • Results depend on the doctor administering the test: interpretation of results can vary from doctor to doctor

    • Highly time-sensitive: pressure in compartment starts dropping as soon as patient stops exercising, so accuracy of measurement decreases with time

The hassle of the diagnostic procedure for CECS is partially responsible for the fact that the disease widely underdiagnosed (Buerba et al)

Other Technologies

    • Slit catheters: a catheter with a tip consisting of sensitive transducers is inserted into the target muscle compartment, the transducers measure intracompartmental pressure

      • Catheter insertion is slow, making measurements inaccurate

    • Near-infrared spectroscopy measures oxygen saturation in hemoglobin

      • Currently not sensitive enough to differentiate between those with and without CECS

    • Magnetic resonance imaging (MRI) uses image intensity (brightness of tissue) to determine pressure differences

      • Quality and accuracy of data unreliable