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Articoli di riviste sul tema "Chronic posterior compartment syndrome"

Autore: Grafiati

Pubblicato: 4 giugno 2021

Ultima modifica: 13 febbraio 2022

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1

Gross, ChristopherE, BelaJ Parekh, SamuelB Adams e SeleneG Parekh. "Chronic exertional compartment syndrome of the superficial posterior compartment: Soleus syndrome". Indian Journal of Orthopaedics 49, n. 5 (2015): 573. http://dx.doi.org/10.4103/0019-5413.164048.

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Grechenig, Peter, Epaminondas Markos Valsamis, Tom Müller, Axel Gänsslen e Gloria Hohenberger. "Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study". Orthopaedic Journal of Sports Medicine 8, n. 10 (1 ottobre 2020): 232596712095692. http://dx.doi.org/10.1177/2325967120956924.

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Background: Chronic exertional compartment syndrome (CECS) is a recognized clinical diagnosis in running athletes and military recruits. Minimally invasive fasciotomy techniques have become increasingly popular, but with varied results and small case numbers. Although decompression of the anterior and peroneal compartments has demonstrated a low rate of iatrogenic injury, little is known about the safety of decompressing the deep posterior compartment. Purpose: To evaluate the risk of iatrogenic injury when using minimally invasive techniques to decompress the anterior, peroneal, and deep posterior compartments of the lower leg. Study Design: Descriptive laboratory study. Methods: A total of 60 lower extremities from 30 adult cadavers were subject to fasciotomy of the anterior, peroneal, and deep posterior compartments using a minimally invasive technique. Two common variations in surgical technique were employed to decompress each compartment. Anatomical dissection was subsequently carried out to identify incomplete division of the fascia, muscle injury, neurovascular injury, and the anatomical relationship of key neurovascular structures to the incisions. Results: Release of the anterior and peroneal compartments was successful in all but 2 specimens. There was no injury to the superficial peroneal nerve or any vessel in any specimen. A transverse incision crossing the anterior intermuscular septum resulted in muscle injury in 20% of the cases. Release of the deep posterior compartment was successful in all but 1 specimen when a longitudinal skin incision was used, without injury to neurovascular structures. Compared with a longitudinal incision, a transverse skin incision resulted in fewer complete releases of the deep posterior compartment and a significantly higher rate of injury to the saphenous nerve (16.7%; P = .052) and long saphenous vein (23.3%; P = .011). Conclusion: Minimally invasive fasciotomy of the anterior, peroneal, and deep posterior compartments using longitudinal incisions had a low rate of iatrogenic injury in a cadaveric model. Complete compartment release was achieved in 97% to 100% of specimens when employing this technique. Clinical Relevance: Minimally invasive fasciotomy techniques for CECS have become increasingly popular with purported low recurrence rates, improved cosmesis, and faster return to sport. It is important to determine whether this technique is safe, particularly given the variable rates of neurovascular injury reported in the literature.

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Winkes, Michiel B., Adwin R. Hoogeveen, Saskia Houterman, Anouk Giesberts, Pieter F. Wijn e Marc R. Scheltinga. "Compartment Pressure Curves Predict Surgical Outcome in Chronic Deep Posterior Compartment Syndrome". American Journal of Sports Medicine 40, n. 8 (22 giugno 2012): 1899–905. http://dx.doi.org/10.1177/0363546512449324.

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4

Wiley, J. Preston, W. Bruce Short, David A. Wiseman e Stephen D. Miller. "Ultrasound catheter placement for deep posterior compartment pressure measurements in chronic compartment syndrome". American Journal of Sports Medicine 18, n. 1 (gennaio 1990): 74–79. http://dx.doi.org/10.1177/036354659001800112.

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5

Lavery, Kyle P., Michael Bernazzani, Kevin McHale, William Rossy, Luke Oh e George Theodore. "Mini-Open Posterior Compartment Release for Chronic Exertional Compartment Syndrome of the Leg". Arthroscopy Techniques 6, n. 3 (giugno 2017): e649-e653. http://dx.doi.org/10.1016/j.eats.2017.01.010.

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6

Lavery, Kyle P., Bertrand W. Parcells e Timothy Hosea. "Posterior Tibial Arterial System Deficiency Mimicking Chronic Exertional Compartment Syndrome". JBJS Case Connector 6, n. 3 (14 settembre 2016): e72. http://dx.doi.org/10.2106/jbjs.cc.15.00071.

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7

Winkes, Michiel B., e Marc R. Scheltinga. "Chronic exertional compartment syndrome of the deep posterior lower leg". British Journal of Sports Medicine 52, n. 19 (26 marzo 2018): 1279–80. http://dx.doi.org/10.1136/bjsports-2017-098002.

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8

Boissonneault, Adam, Taylor Bellamy e Sameh Labib. "Release of Tibialis Posterior Muscle Osseofascial Sheath for Chronic Exertional Compartment Syndrome Leads to Improved Outcomes". Foot & Ankle Orthopaedics 3, n. 3 (1 luglio 2018): 2473011418S0003. http://dx.doi.org/10.1177/2473011418s00031.

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Category: Sports Introduction/Purpose: Success rates for surgical management of chronic exertional compartment syndrome (CECS) in the lower extremity are influenced by the leg compartment involved. A failure rate of 40-50% has been associated with release of the deep posterior compartment, which has historically been associated with significantly worse outcomes than isolated anterolateral releases. The tibialis posterior muscle often resides in a separate osseofascial sheath, the so-called “fifth compartment.” At our institution, when a deep posterior release is performed, we routinely examine for this fifth compartment and release it if present. Within the context of this surgical approach, the aim of the current study was to compare long-term patient satisfaction and activity levels in those that underwent 2-versus 4-compartment fasciotomy for CECS. Methods: Our study reports on 48 limbs from 31 patients associated with a consecutive series that presented to a single institution for surgical management of lower extremity CECS from 2007-2016. The mean (standard deviation) follow-up was 65 (+/- 28) months. All patients underwent pre-operative intramuscular compartment pressure testing for CECS diagnosis. All surgeries were performed by a single surgeon. In all patients in which 4-compartment fasciotomy was indicated, the tibialis posterior muscle was examined for a separate osseofascial sheath. This sheath was released when present. The presence or absence of the sheath was always dictated in the operative note. Patient satisfaction outcomes were assessed with a Likert scale (excellent, good, fair, or poor). Current activity level was assessed via Marx and Tegner activity scores. Results: Of the 48 limbs, 29 limbs received 2-compartment anterolateral releases only and 19 limbs received 4-compartment fasciotomies. Of those that received 4-compartment fasciotomies, 13 (68%) were found to have a separate osseofascial sheath surrounding the tibialis posterior muscle. At a mean 5-year follow-up interval, 77% of the total cohort rated their outcome as good or excellent. Among the 4-comparment fasciotomy sub-cohort, 79% of patients rated their outcome as good or excellent. Among the entire cohort, there were no revision surgeries performed. The overall mean Tegner and Marx activity scores were 6 and 11 respectively. There was no significant difference in mean outcome scores between those that had 2-versus 4-compartment fasciotomies. Conclusion: Our study illustrates that 1) a separate osseofascial sheath exists around the tibialis posterior muscle in the majority of cases and 2) if this fifth compartment is consistently examined for and released, patients can achieve equivalent success rates and return to a similarly high activity level as those that undergo 2-compartment fasciotomy for CECS. Our study demonstrates superior results for 4-compartment release and includes the longest mean follow-up time for CECS patients in the literature.

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9

Kwiatkowski, Timothy C., e Don E. Detmer. "Anatomical dissection of the deep posterior compartment and its correlation with clinical reports of chronic compartment syndrome involving the deep posterior compartment". Clinical Anatomy 10, n. 2 (1997): 104–11. http://dx.doi.org/10.1002/(sici)1098-2353(1997)10:2<104::aid-ca6>3.0.co;2-v.

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10

van Zantvoort, Aniek, Johan de Bruijn, Henricus Hundscheid, Marike van der Cruijsen-Raaijmakers, Joep Teijink e Marc Scheltinga. "Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome". International Journal of Sports Medicine 39, n. 14 (12 novembre 2018): 1081–87. http://dx.doi.org/10.1055/a-0640-9104.

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AbstractExercise-induced lower leg pain may be caused by chronic exertional compartment syndrome (CECS). Anterior or deep posterior compartments are usually affected. Knowledge about CECS of the lateral compartment (lat-CECS) is limited and outcome after fasciotomy is unknown. The purpose of this study is to report on success rates of fasciotomy in patients with lat-CECS. Surgical success rates in patients with lat-CECS diagnosed with a dynamic intracompartmental pressure (ICP) measurement were studied using a questionnaire (success: excellent or good as judged by the patient; unsuccessful: moderate, fair or poor). We conducted ICP measurements in 247 patients for suspected lat-CECS, of whom 78 were positively diagnosed. Following exclusion (n=11), 30 of the eligible 67 patients completed the questionnaire. Bilateral (70%, n=21/30) exertional pain (97%, n=29) and a feeling of tightness (93%, n=28) were the most frequently reported symptoms. Four years after fasciotomy, severity and frequency of symptoms had dropped significantly. Long-term surgical success was reported by 33% (n=10; excellent n=4, good n=6). Seventy-three percent (n=22) had resumed sports activities (9 same level, 13 lower level). In conclusion, a fasciotomy for lat-CECS was successful in the long term in just one of three operated patients in this retrospective study.

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C Oseto, Matthew, John Z Edwards e Raymond W Acus. "Posterior Thigh Compartment Syndrome Associated With Hamstring Avulsion and Chronic Anticoagulation Therapy". Orthopedics 27, n. 2 (1 febbraio 2004): 229–30. http://dx.doi.org/10.3928/0147-7447-20040201-20.

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12

Winkes, Michiel, Percy van Eerten e Marc Scheltinga. "Deep posterior chronic exertional compartment syndrome as a cause of leg pain". Der Unfallchirurg 123, S1 (16 maggio 2019): 3–7. http://dx.doi.org/10.1007/s00113-019-0665-1.

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van Zantvoort, Antonia P. M., Henricus P. H. Hundscheid, Johan A. de Bruijn, Adwin R. Hoogeveen, Joep A. W. Teijink e Marc R. M. Scheltinga. "Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?" Orthopaedic Journal of Sports Medicine 7, n. 12 (1 dicembre 2019): 232596711989010. http://dx.doi.org/10.1177/2325967119890105.

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Background: Chronic exertional compartment syndrome (CECS) mostly occurs in the anterior or deep posterior compartments (ant-CECS and dp-CECS, respectively) of the leg. It is generally accepted that CECS of the third or lateral compartment (lat-CECS) always occurs together with ant-CECS. However, whether exertional leg pain (ELP) can be caused by an isolated form of lat-CECS is unknown. Purpose: To determine the existence of isolated lat-CECS and study whether history taking and a physical examination aid in discriminating between different subtypes of CECS. Study Design: Case series; Level of evidence, 4. Methods: Patients were eligible for this single-center study, conducted between January 2013 and February 2018, if they reported anterolateral ELP and completed a questionnaire scoring the frequency and intensity of pain, tightness, cramps, muscle weakness, and paresthesia during rest and exercise. They were asked to mark areas of altered foot skin sensation, if present, on a drawing. All patients underwent a dynamic intracompartmental pressure (ICP) measurement of the anterior and lateral compartments simultaneously. The diagnosis of CECS was confirmed by elevated ICP (Pedowitz criteria). There were 3 patient groups: (1) isolated ant-CECS with elevated ICP in the anterior compartment and normal ICP in the lateral compartment, (2) isolated lat-CECS with elevated ICP in the lateral compartment but normal ICP in the anterior compartment, and (3) ant-/lat-CECS with elevated ICP in both the anterior and lateral compartments. Results: A total of 73 patients with anterolateral ELP fulfilled study criteria (isolated ant-CECS: n = 26; isolated lat-CECS: n = 5; ant-/lat-CECS: n = 42). Group differences were not observed regarding age (isolated ant-CECS: median, 26 years [range, 13-68 years]; isolated lat-CECS: median, 20 years [range, 17-63 years]; ant-/lat-CECS: median, 28 years [range, 17-57 years]; χ2 (2) = 0.466; P = .79), sex (isolated ant-CECS: 50% male; isolated lat-CECS: 40% male; ant-/lat-CECS: 62% male; P = .49), or bilateral symptoms (isolated ant-CECS: 54%; isolated lat-CECS: 80%; ant-/lat-CECS: 69%; P = .40). However, cramps at rest were present in a portion of the patients with isolated ant-CECS (38%) and ant-/lat-CECS (57%) but not in those with isolated lat-CECS ( P = .032). Patient drawings of altered foot skin sensation did not contribute to the diagnosis ( P = .92). ICP values after provocation were all lower in patients with isolated ant-CECS and isolated lat-CECS compared with those with ant-/lat-CECS ( P < .05). Conclusion: Seven percent of patients with CECS and anterolateral ELP who had symptoms due to isolated lat-CECS in the presence of normal muscle pressure in the anterior compartment.

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van Zoest, W., A. Hoogeveen, M. Scheltinga, H. Sala, J. van Mourik e P. Brink. "Chronic Deep Posterior Compartment Syndrome of the Leg in Athletes: Postoperative Results of Fasciotomy". International Journal of Sports Medicine 29, n. 5 (aprile 2008): 419–23. http://dx.doi.org/10.1055/s-2007-965365.

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15

Barbour, T. D. A. "Histology of the fascial-periosteal interface in lower limb chronic deep posterior compartment syndrome". British Journal of Sports Medicine 38, n. 6 (1 dicembre 2004): 709–17. http://dx.doi.org/10.1136/bjsm.2003.007039.

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16

Biedert, R., e B. Marti. "Intracompartmental Pressure before and after Fasciotomy in Runners with Chronic Deep Posterior Compartment Syndrome". International Journal of Sports Medicine 18, n. 05 (luglio 1997): 381–86. http://dx.doi.org/10.1055/s-2007-972650.

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Bellamy, J. Taylor, Adam R. Boissonneault, Morgan E. Melquist e Sameh A. Labib. "Release of the Tibialis Posterior Muscle Osseofascial Sheath Improves Results of Deep Exertional Compartment Syndrome Surgery: A Comparative Analysis and Long-term Results". Orthopaedic Journal of Sports Medicine 8, n. 8 (1 agosto 2020): 232596712094275. http://dx.doi.org/10.1177/2325967120942752.

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Background: Success rates for surgical management of chronic exertional compartment syndrome (CECS) are historically lower with release of the deep posterior compartment compared with isolated anterolateral releases. At our institution, when a deep posterior compartment release is performed, we routinely examine for a separate posterior tibial muscle osseofascial sheath and release it if present. Purpose: Within the context of this surgical approach, the aim of the current study was to compare long-term patient satisfaction and activity levels in patients who underwent 2-compartment fasciotomy versus a modified 4-compartment fasciotomy for CECS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients treated with fasciotomy for lower extremity CECS from 2007 to 2017 were retrospectively identified. In all patients in whom a 4-compartment fasciotomy was indicated, the tibialis posterior muscle was examined for a separate osseofascial sheath, which was released when present. Patients completed a series of validated patient-reported outcome (PRO) surveys, including the Marx activity score, Tegner activity score, 12-Item Short Form Health Survey, and Likert score for patient satisfaction. Results: Of the 48 patients who were included in this study, 34 (71%) patients with a total of 52 operative limbs responded and completed PRO surveys. The mean follow-up for the entire cohort was 5.5 ± 2.6 years. Of the 34 patients, 23 (68%) underwent 2-compartment fasciotomy and 11 (32%) underwent 4-compartment fasciotomy. Among the patients in the 4-compartment fasciotomy group, 7 (64%) were found to have a fifth compartment. No significant difference was found in any of the validated PRO measures between patients who had a 2- versus 4-compartment fasciotomy or those who underwent 4-compartment fasciotomy with or without a present fifth compartment. At a mean 5.5-year follow-up, 74% of patients who underwent a 2-compartment release reported good or excellent outcomes compared with 82% of patients who underwent our modified 4-compartment release. Conclusion: The current study, which included the longest follow-up on CECS patients in the literature, demonstrated that the addition of a release of the posterior tibial muscle fascia led to no significant difference in PRO measures between patients who underwent a 2- versus 4-compartment fasciotomy, when historically the 2-compartment fasciotomy group has had higher success rates.

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Mangan, John J., Ryan G. Rogero, Daniel Corr, Daniel J. Fuchs, Joseph T. O’Neil e Steven M. Raikin. "Predictors of Improvement in Patient Outcomes after Fasciotomy for Chronic Exertional Compartment Syndrome of the Lower Leg". Foot & Ankle Orthopaedics 5, n. 4 (1 ottobre 2020): 2473011420S0005. http://dx.doi.org/10.1177/2473011420s00058.

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Category: Sports; Other Introduction/Purpose: Chronic exertional compartment syndrome (CECS) of the lower leg is the result of increased pressure in intramuscular compartments that occurs during repetitive physical activity. Previous studies have demonstrated the effectiveness of lower extremity fasciotomies in treating CECS. However, not all patients have the same level of symptom improvement or ability to return to sport. The purpose of this study was to determine if any independent patient variables were predictive of outcomes following fasciotomy for CECS of the lower leg. Methods: A retrospective review of patients undergoing fasciotomy of the lower leg for treatment of CECS by a single fellowship-trained orthopaedic surgeon from 2009 to 2017 was performed. All patients had a diagnosis confirmed by pre- and post-exercise compartment pressure testing using the Pedowitz criteria. Patients that underwent a fasciotomy for trauma, infection, or an acute pathologic process or underwent revision fasciotomy were excluded. Preoperative measures of Foot and Ankle Ability Measure-Sport subscale (FAAM-Sport), FAAM-Sport single assessment numeric evaluation (SANE), and visual analog scale (VAS) for pain during sporting activities were collected. Patients with at least 12 months of follow-up were included. The primary outcomes of change (delta, Δ) in FAAM-Sport, FAAM-Sport SANE, and VAS during sporting activities were calculated. To determine significant predictors of outcomes, a generalized multivariate linear regression model developed based on univariate analysis and clinical experience was used. Statistical significance was set at p<0.05. Results: In total, 61 patients underwent 65 procedures, with outcome measures obtained on average 57.9 (range, 12-115) months postoperatively. Median age was 22, median BMI was 24.4, and 59.0% of the cohort was female. Of the 65 fasciotomies, 39 (60.0%) were simultaneous bilateral, 6 procedures (9.2%) performed on 3 patients were staged bilateral, and 18 (27.7%) were unilateral. There were 16 four-compartment fasciotomies performed (24.6%), while 49 (75.4%) involved 2 compartments. Twenty- two procedures involved deep posterior compartment pressures meeting the Pedowitz criteria. Patients had mean (+- standard deviation) improvement in FAAM-Sport of 40.4 +- 22.3 points (p<0.001), improvement in FAAM-Sport SANE of 57.3 +- 31.6 (p<0.001), and reduction of VAS pain of 56.4 +- 31.8 (p<0.001). Multivariate linear regression results are listed in Table 1. Conclusion:: Fasciotomy is an effective treatment of CECS, with our study identifying certain patient variables leading to greater improvement. Independent predictors of improvement of FAAM-Sport SANE following surgery included younger age, history of depression, and male sex. A history of depression was an independent predictor of greater VAS pain reduction following fasciotomy. Patients with deep posterior compartment pressure testing meeting the Pedowitz criteria was an independent predictor of increased improvement in FAAM-Sport. To our knowledge, this is the first study to investigate and identify independent patient variables predictive of greater functional improvement following fasciotomy for CECS. [Table: see text]

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Mangan, John J., Ryan Rogero, Daniel J. Fuchs e Steven M. Raikin. "Surgical Management of Chronic Exertional Compartment Syndrome of the Lower Extremity: Outcome Analysis and Return to Sport". Foot & Ankle Orthopaedics 4, n. 4 (1 ottobre 2019): 2473011419S0005. http://dx.doi.org/10.1177/2473011419s00053.

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Category: Sports Introduction/Purpose: Chronic exertional compartment syndrome (CECS) occurs as the result of increasing pressure in a closed muscular compartment, typically in the leg, as the result of repetitive activity. Physiologic changes in myofibril size during exercise increase muscle volume leading to higher compartmental pressures, which can result in neurologic and vascular changes. CECS has been estimated to cause 27%-33% of exertional leg pain and frequently leads to a decrease in athletic training and competition. CECS affects males and females equally but is especially common in young athletes, particularly competitive runners, as well as soccer, field hockey and lacrosse players and in military personnel. The purpose of this study is to evaluate patient- reported outcomes and return to sport (RTS) after open fasciotomy for lower extremity CECS. Methods: A retrospective review of patients that underwent lower extremity fasciotomy for CECS by a single surgeon was performed. All patients had a diagnosis confirmed by pre- and post-exercise compartment pressure testing. Two-incision technique was used with lateral and anterior compartments released through a lateral incision, while deep and superficial posterior compartments were released through a medial approach when indicated. Patients that underwent a fasciotomy for trauma, infection, or an acute pathologic process were excluded. Patient outcome measures were recorded for each patient including the Foot and Ankle Ability Measure-Sport subscale (FAAM-Sport), FAAM-Sport Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS) for pain. A novel RTS questionnaire was designed and implemented. Patient demographic information was included. Outcome analysis was performed using Student’s t-test and chi-square testing. RTS was compared using Mann-Whitney U testing, and regression analysis was used to identify independent risk factors for failure to RTS. Results: 59 patients that underwent 63 procedures were included. Average age was 26.6 years (range, 15-55), 59.3% were female, and average follow-up was 58.8 months (range, 12-115). 37 patients underwent simultaneous bilateral fasciotomies, 8 had staged bilateral fasciotomies and 18 underwent unilateral fasciotomy. Four-compartment fasciotomy was performed 14 times and 49 fasciotomies involved one or two compartments. Significant postoperative improvement was seen in the FAAM-Sport, Sport SANE and the VAS for pain compared to preoperative scores (p<0.001). Overall 93.2% (55/59) of patients were able to return to sport, 78.1% (43/55) returned to the same level of sport, and 21.9% (12/54) returned to a lower level of competition. Bivariate regression analysis demonstrated that higher preoperative BMI (p=0.049) was associated with a lower likelihood of return to sport. Conclusion: CECS is a relatively common problem seen in young athletes and can cause significant change in athletic participation and ability. This cohort of patients who underwent lower extremity fasciotomies for CECS is larger than any previously published. This study demonstrates that lower extremity fasciotomy for CECS results in improvement of patient-reported outcomes and returns athletes back to competition at a high rate.

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Winkes, Michiel B., Carroll M. Tseng, Huub L. Pasmans, Marike van der Cruijsen-Raaijmakers, Adwin R. Hoogeveen e Marc R. Scheltinga. "Accuracy of Palpation-Guided Catheter Placement for Muscle Pressure Measurements in Suspected Deep Posterior Chronic Exertional Compartment Syndrome of the Lower Leg". American Journal of Sports Medicine 44, n. 10 (21 luglio 2016): 2659–66. http://dx.doi.org/10.1177/0363546516652113.

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D’HERBEMONT, SOPHIE, ANDRÉS HUMBERTO MORALES-MARTÍNEZ e IGNACIO PAVEL NAVARRO-CHÁVEZ. "CERVICAL NEURENTERIC CYST: A CASE REPORT". Coluna/Columna 18, n. 3 (settembre 2019): 251–53. http://dx.doi.org/10.1590/s1808-185120191803172096.

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ABSTRACT Objective Neurenteric cysts account for 0.7–1.3% of all spinal cord tumors. These rare lesions are composed of heterotopic endodermal tissue. Methods A 26-year-old woman with a 13-month history of severe cervicalgia and brachial paresthesia. Clinically she had mildbilateral brachial paresis (4/5), generalized hyperreflexia and a left Babinski Sign. Past medical history was significant for a cervical fistula closure when she was 1yearold. The superior somatosensory evoked potentials revealed medullary axonal damage with a left predominance. A cervical magnetic resonance imaging of the neck was performed showing a dorsal homogeneous cystic intradural extramedullary lesion with high signal intensity on T2. Computed tomography revealed a Klippel-Feil syndrome. Results A posterior laminectomy and surgical excision were performed without complications. Post-operative follow-up showed a complete recovery of arm strength. The histopathological report confirmed the preoperative diagnosis of neurenteric cyst. Most neurenteric cysts are located in the spine, mainly in a ventral position. A total of 95% of neurenteric cysts are found in the intradural/intramedullary compartment. Symptomatic neurenteric cysts typically appear in the second and third decades of life and are 1.5 to 3 times more common in men. In 50% of the cases, other vertebral malformations have also been reported. In this case, a congenital dorsal enteric cyst and a Klippel-Feil syndrome were observed. Conclusions The intraspinal neurenteric cysts are rare lesions that must be included in the differential diagnosis of a dorsal, intradural cystic structure. The diagnosis may be overlooked, especially in cases of chronic neck pain without neurological deficit. Level of evidence V; Expert Opinion.

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Cain, E. Lyle, Jeffrey R. Dugas, Robert S. Wolf e James R. Andrews. "Elbow Injuries in Throwing Athletes: A Current Concepts Review". American Journal of Sports Medicine 31, n. 4 (luglio 2003): 621–35. http://dx.doi.org/10.1177/03635465030310042601.

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Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.

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Amarasooriya, Melanie, Gregory Ian Bain, Tom Roper, Kimberley Bryant, Karim Iqbal e Joideep Phadnis. "Complications After Distal Biceps Tendon Repair: A Systematic Review". American Journal of Sports Medicine 48, n. 12 (24 febbraio 2020): 3103–11. http://dx.doi.org/10.1177/0363546519899933.

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Background: Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature. Purpose: To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications. Study Design: Systematic review. Methods: Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods. Results: Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of <0.1% each. The majority of nerve injuries resolved with an expectant approach. The minor complication rate was 20.4% (n = 630). The most common complication was lateral cutaneous nerve injury (9.2%, n = 283). An extensile single incision was associated with a higher rate of superficial radial nerve injury when compared to limited single incision(6% vs 2.1%, P = .002). Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. (9.7% vs 5.2%, P = .03). Synostosis occurred only with double incision. Fixation technique had no significant effect on rerupture rate and posterior interosseous nerve injury rate. Conclusion: This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent. Registration: CRD42017074066 (PROSPERO).

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RORABECK, C. H. "Exertional Tibialis Posterior Compartment Syndrome". Clinical Orthopaedics and Related Research &NA;, n. 208 (luglio 1986): 61???64. http://dx.doi.org/10.1097/00003086-198607000-00013.

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25

Ross, Dennis G. "Chronic Compartment Syndrome". Orthopaedic Nursing 15, n. 3 (maggio 1996): 23???26. http://dx.doi.org/10.1097/00006416-199605000-00005.

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26

Rettig, Arthur C., John R. McCarroll e Robyn G. Hahn. "Chronic Compartment Syndrome". Physician and Sportsmedicine 19, n. 4 (aprile 1991): 63–70. http://dx.doi.org/10.1080/00913847.1991.11702191.

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27

TURNIPSEED, WILLIAM, DON E. DETMER e FORREST GIRDLEY. "Chronic Compartment Syndrome". Annals of Surgery 210, n. 4 (ottobre 1989): 557. http://dx.doi.org/10.1097/00000658-198910000-00016.

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28

Chitalia, Ami, David Swoboda e Catherine Broome. "Management of Catastrophic Antiphosphopholipid Syndrome with Eculizumab". Blood 128, n. 22 (2 dicembre 2016): 2603. http://dx.doi.org/10.1182/blood.v128.22.2603.2603.

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Abstract Catastrophic antiphospholipid syndrome (CAPS) is a rare, often fatal phenomenon. Patients present with a wide range of symptomatology including thrombotic microangiopathy, cytopenias and end organ damage. The mortality rate of CAPS is as high as 33% in spite of the use of combination therapies including steroids, anticoagulation, plasma exchange (PEX) and intravenous immunoglobulin (Cervera CA 2009; Espinosa G 2011; Bucciarelli S 2006). CAPS is believed to be a disorder of complement-mediated inflammation which results in tissue injury. The proposed mechanism of the thrombotic microangiopathyisthe interaction of the coagulation cascade and complement (Mehdi AA 2010). Multiple murine-based studies demonstrate the contribution of C5a to antiphospholipid antibody-mediated intravascular thrombosis (Fischetti F 2005; Pierangeli SS 2005; Giannakopoulos B 2013). Eculizumab is a humanized monoclonal antibody that binds to C5 and inhibits its cleavage to C5a and C5b. It is FDA approved for the treatment of the complement mediated disorders paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome. We present 3 cases of CAPS treated with eculizumab at our institution. Their individual diagnostic criteria and background characteristics are outlined in Table 1. Case 1: 41-year-old male with history of antiphospholipid syndrome on chronic anticoagulation presented with fevers and ventilatory-dependent respiratory failure. Upon transfer to our institution, he developed thrombocytopenia and left hand mottling; doppler revealed a radial artery thrombus. Biopsy of the involved area of skin indicated thrombotic microangiopathy. Pulse dose steroids and unfractionated heparin were initiated. He was extubated within 24 hours and fever resolved. He remained dyspneic and mildly thrombocytopenic and therefore rituximab was initiated. Oxygen requirements, liver dysfunction, and thrombocytopenia resolved. As the prednisone dose was tapered, new microangiopathic lesions were noted. The decision was made to start eculizumab which is ongoing as a maintenance dose every two weeks with no clinical recurrence of CAPS. Case 2: 68-year-old male presented with priapism. On day 2 of hospitalization, he was found to have left lower extremity (LLE) DVTs and received unfractionated heparin. On day 4, he developed fever and thrombocytopenia and was noted to have a cold LLE. Angiography demonstrated occlusion of the posterior tibial artery and heparin was discontinued in favor of an alteplase drip. The patient was subsequently transferred to our institution. Doppler demonstrated multiple DVTs in both lower extremities. Evaluation for HIT was negative. Lupus anticoagulant (LA) was strongly positive raising concern for CAPS. Steroids and PEX were initiated. However, emergency fasciotomy of the RLE was needed to relieve compartment syndrome. Skin biopsy demonstrated microangiopathy. Due to lack of clinical improvement, PEX was discontinued and eculizumab was initiated. On day 3 post-eculizumab initiation, there was evidence of regression of skin mottling. Eculizumab was redosed on day 5. Steroids were tapered and he received 2 additional doses of eculizumab. No additional thrombotic complications occurred. He eventually died during this hospitalization due to septic shock. Case 3: 37-year-old female presented with fever, hypoxia, and painful feet. She was hypotensive and labs demonstrated leukopenia, thrombocytopenia, elevated liver enzymes, and acute kidney injury. Vasopressors and antibiotics were initiated. Over the next 24 hours she developed mottling of her feet, face and breasts. The diagnosis of CAPS was made based on clinical criteria and a positive LA. Unfractionated heparin, steroids and eculizumab were initiated. Dialysis was started due to renal failure. Skin biopsy showed microangiopathy. Marked improvement of skin mottling was noted after 3 doses of eculizumab and renal function normalized after 7 doses. She was discharged with a slow steroid taper, therapeutic enoxaparin, and maintenance eculizumab. Complement blockade with eculizumab is safe and effective in patients with CAPS. These cases suggest that utilizing therapy to inhibit the complement pathway may be an integral component in treating CAPS more effectively. Future directions should include a randomized clinical trial to evaluate eculizumab as part of combination therapy for CAPS. Disclosures Broome: True North Therapeutics: Honoraria; Alexion Pharmaceuricals: Honoraria.

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Hutchinson, Mark R., Mary Lloyd Ireland e William O. Roberts. "Chronic Exertional Compartment Syndrome". Physician and Sportsmedicine 27, n. 5 (maggio 1999): 101–2. http://dx.doi.org/10.3810/psm.1999.05.871.

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30

Fraipont, Michael J., e Gregory J. Adamson. "Chronic Exertional Compartment Syndrome". Journal of the American Academy of Orthopaedic Surgeons 11, n. 4 (luglio 2003): 268–76. http://dx.doi.org/10.5435/00124635-200307000-00006.

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31

Baumgarten, Keith M. "Chronic Exertional Compartment Syndrome". Journal of Bone and Joint Surgery 95, n. 7 (aprile 2013): e48. http://dx.doi.org/10.2106/jbjs.m.00020.

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32

Paik, R. S., D. Pepples e M. R. Hutchinson. "Chronic exertional compartment syndrome". BMJ 346, jan15 2 (15 gennaio 2013): f33. http://dx.doi.org/10.1136/bmj.f33.

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33

Murray, Matthew C., e Michael M. Heckman. "Chronic Exertional Compartment Syndrome". Techniques in Orthopaedics 27, n. 1 (marzo 2012): 75–78. http://dx.doi.org/10.1097/bto.0b013e3182488423.

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34

Hutchinson, M. "Chronic exertional compartment syndrome". British Journal of Sports Medicine 45, n. 12 (25 maggio 2011): 952–53. http://dx.doi.org/10.1136/bjsports-2011-090046.

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35

Hislop, Matthew, Paul Tierney, Pairic Murray, Moira O'Brien e Nick Mahony. "Chronic Exertional Compartment Syndrome". American Journal of Sports Medicine 31, n. 5 (settembre 2003): 770–76. http://dx.doi.org/10.1177/03635465030310052201.

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36

Pritchard, M. H., H. Cohen, R. Williams, D. Fagan e J. P. Heath. "Chronic forearm compartment syndrome". Clinical Neurophysiology 118, n. 5 (maggio 2007): e158-e159. http://dx.doi.org/10.1016/j.clinph.2006.07.246.

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37

Braver, Richard T. "Chronic Exertional Compartment Syndrome". Clinics in Podiatric Medicine and Surgery 33, n. 2 (aprile 2016): 219–33. http://dx.doi.org/10.1016/j.cpm.2015.12.002.

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38

George, Christopher A., e Mark R. Hutchinson. "Chronic Exertional Compartment Syndrome". Clinics in Sports Medicine 31, n. 2 (aprile 2012): 307–19. http://dx.doi.org/10.1016/j.csm.2011.09.013.

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39

Dunlop, D., P. J. Parker e J. F. Keating. "Ruptured Baker's cyst causing posterior compartment syndrome". Injury 28, n. 8 (ottobre 1997): 561–62. http://dx.doi.org/10.1016/s0020-1383(97)00105-8.

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40

Petros, D. P., J. F. Hanley, P. Gilbreath e R. D. Toon. "Posterior compartment syndrome following ruptured Baker's cyst." Annals of the Rheumatic Diseases 49, n. 11 (1 novembre 1990): 944–45. http://dx.doi.org/10.1136/ard.49.11.944.

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41

Wittstein, Jocelyn, Claude T. Moorman e L. Scott Levin. "Endoscopic Compartment Release for Chronic Exertional Compartment Syndrome". American Journal of Sports Medicine 38, n. 8 (16 aprile 2010): 1661–66. http://dx.doi.org/10.1177/0363546510363415.

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42

Knight, Justin R., Marissa Daniels e William Robertson. "Endoscopic Compartment Release for Chronic Exertional Compartment Syndrome". Arthroscopy Techniques 2, n. 2 (maggio 2013): e187-e190. http://dx.doi.org/10.1016/j.eats.2013.02.002.

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43

Naito, Masatoshi, Kosuke Ogata, Takefumi Kuroki, Hidetoshi Naito, Wataru Kawano e Yoshiyasu Murakawa. "Chronic compartment syndrome in athletes." Orthopedics & Traumatology 34, n. 1 (1985): 177–79. http://dx.doi.org/10.5035/nishiseisai.34.177.

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44

Almdahl, Sven M., e Frode Samdal. "Fasciotomy for chronic compartment syndrome". Acta Orthopaedica Scandinavica 60, n. 2 (gennaio 1989): 210–11. http://dx.doi.org/10.3109/17453678909149257.

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45

Housner, Jeffrey A. "Acute-on-Chronic Compartment Syndrome". Physician and Sportsmedicine 25, n. 5 (maggio 1997): 24. http://dx.doi.org/10.1080/00913847.1997.11440229.

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46

Flick, David, e Renee Flick. "Chronic Exertional Compartment Syndrome Testing". Current Sports Medicine Reports 14, n. 5 (2015): 380–85. http://dx.doi.org/10.1249/jsr.0000000000000187.

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47

Xu, Y. M., Y. H. Bai, Q. T. Li, H. Yu e M. L. Cao. "Chronic lumbar paraspinal compartment syndrome". Journal of Bone and Joint Surgery. British volume 91-B, n. 12 (dicembre 2009): 1628–30. http://dx.doi.org/10.1302/0301-620x.91b12.22647.

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48

Roscoe, David, Andrew J. Roberts e David Hulse. "Intramuscular Compartment Pressure Measurement in Chronic Exertional Compartment Syndrome". American Journal of Sports Medicine 43, n. 2 (18 novembre 2014): 392–98. http://dx.doi.org/10.1177/0363546514555970.

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49

Krysa, J., R. Lofthouse e G. Kavanagh. "Gluteal compartment syndrome following posterior cruciate ligament repair". Injury 33, n. 9 (novembre 2002): 835–38. http://dx.doi.org/10.1016/s0020-1383(02)00092-x.

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50

Allen, M. J., e M. R. Barnes. "Unusual cause of acute superficial posterior compartment syndrome". Injury 23, n. 3 (gennaio 1992): 202–3. http://dx.doi.org/10.1016/s0020-1383(05)80049-x.

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