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Stiffness and Thickness of Fascia Do Not Explain Chronic Exertional Compartment Syndrome

  • Basic Research
  • Published:
Clinical Orthopaedics and Related Research®

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.

Questions/purposes

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.

Patients and 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.

Level of Evidence

Level II, prognostic study. See the guidelines online for a complete description of level of evidence.

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Acknowledgments

We thank Anna-Karin Olofsson for technical assistance and Professor Göran Toolanen for valuable support and advice.

Author information

Authors and Affiliations

  1. Institute of Sports Medicine, Department 8, Bispebjerg Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Morten Dahl MD, Philip Hansen PhD & S. Peter Magnusson DSc

  2. Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden

    Per Stål DSc

  3. Department of Surgery and Perioperative Science, Section for Anatomy, Umeå University, Umeå, Sweden

    David Edmundsson PhD

Authors
  1. Morten Dahl MD
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  2. Philip Hansen PhD
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  3. Per Stål DSc
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  4. David Edmundsson PhD
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  5. S. Peter Magnusson DSc
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Corresponding author

Correspondence to S. Peter Magnusson DSc.

Additional information

The institutions of one or more of the authors have received funding from the Swedish National Centre for Research in Sports (PS, DE) and Institute of Sports Medicine Copenhagen (MD, PH, SPM). Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Umeå University Hospital and Institute of Sports Medicine, Bispebjerg Hospital.

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Dahl, M., Hansen, P., Stål, P. et al. Stiffness and Thickness of Fascia Do Not Explain Chronic Exertional Compartment Syndrome. Clin Orthop Relat Res 469, 3495–3500 (2011). https://doi.org/10.1007/s11999-011-2073-x

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  • DOI: https://doi.org/10.1007/s11999-011-2073-x

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