Elastography in Chronic Exertional Compartment Syndrome in the Active-Duty Population

Chronic exertional compartment syndrome (CECS) is a condition provoked by exercise that is caused by a marked increase in tissue pressure within a closed fascial plane. It is most commonly seen in athletes who participate in ball and puck sports, military recruits, and long distance/high mileage runners. The incidence in the military has been shown to be .49 cases per 1000 patient years. Patients typically present with complaints of pain, recurrent leg cramping, and pressure, that is often identified at a specific point during training. Neurological symptoms may also occur, and include paresthesias or weakness in the distribution of a peripheral nerve.

Current gold standard for diagnosis of CECS is intramuscular compartment pressure measurement. Other methods of diagnosis have been proposed and include magnetic resonance imaging and near infrared spectroscopy (NIRS). However, MRI has been stated to be less reliable than compartment pressure and infrared spectroscopy. The cost, practicality, and availability of MRI or NIRS is a confounding factor in using these technologies for diagnostic decision making.  There remains a need for a reliable, non-invasive, accessible, and cost-effective tool to confirm clinical diagnosis. We hypothesize that this can be done with ultrasound shear wave muscle elastography. Shear wave elastography is an ultrasound-based technique that can characterize tissue mechanical properties.

The long-term objective of this project is to develop a sensitive and non-invasive method of diagnosing CECS using shear wave muscle elastography (SWE) and to compare non-invasive shear wave muscle elastography to invasive pressure monitoring. After intervention, we will assess for objective changes within the symptomatic compartment using ultrasound shear wave elastography.