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Exertional leg pain is a relatively common condition that can negatively impact athletic performance and may pose a diagnostic and management challenge for the sportsmedicine physician. Acomprehensive clinical evaluation is important to narrow the broad differential associated with exertional leg pain and focus the selection of the most appropriate diagnostic tests and treatment modalities in the care of these individuals. This article will provide an update on recent literature regarding the etiologies, pathophysiology, clinical presentation,workup/diagnosis, and treatment of exertional leg pain in athletes with a focus on vascular etiologies, chronic exertional compartment syndrome, and bone stress injury. [ABSTRACT FROM AUTHOR]

Background: Chronic low back pain secondary to degenerative disc disease is a significant public health issue worldwide, contributing to substantial health care burdens and patient disability. Anterior lumbar interbody fusion (ALIF) has emerged as a promising surgical solution, offering benefits such as disc height restoration, reduced neural compression, and improved spinal alignment. This study evaluates the efficacy of stand-alone ALIF using polyetheretherketone (PEEK) cages, structural femoral head allografts, and recombinant human bone morphogenetic protein-2 (rhBMP-2) in treating discogenic low back pain caused by degenerative disc disease. Methods: This prospective case series study included 1335 patients who underwent stand-alone ALIF by a single surgeon. The surgical construct involved PEEK cages with structural femoral allograft dowels and rhBMP-2, supplemented by anterior fixation. Patient-reported outcome measures, including the visual analog scale for back and leg pain, the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and patient satisfaction, were monitored over 12 months. Results: The overall fusion rate was 99.6%, with pseudoarthrosis occurring in 0.2% of patients. Lower fusion rates were observed in patients older than 65 years and those using the Brantigan cage. Significant improvements were seen in visual analog scale for back and leg pain, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores from baseline, with most scores exceeding the substantial clinical benefit thresholds. More than 85% of patients reported "Excellent" or "Good" outcomes. Conclusions: Stand-alone ALIF, augmented with rhBMP-2 and structural femoral head allografts, can enhance mechanical stability, fusion rates, and radiographic assessment. This integrated approach achieves successful spinal fusion and positive clinical outcomes for patients with refractory discogenic low back pain. Clinical Relevance: Stand-alone ALIF with PEEK cages, structural femoral head allografts, and rhBMP-2 demonstrates high fusion rates and significant clinical improvements in patients with discogenic low back pain. This approach enhances spinal stability and promotes biological healing, making it a reliable and effective surgical option. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this systematic review was to ascertain guideline‐recommended pharmaceutical approaches to lumbosacral radicular symptoms, assess the quality of the clinical practice guidelines (CPGs) with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, and qualitatively synthesize the guideline recommendations. Literature Survey: Literature searches were performed in PubMed, Cochrane Database of Systematic Reviews, Index to Chiropractic Literature, Allied and Complementary Medicine Database (AMED), Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro). We included guidelines published between January 1, 2017, and January 9, 2022, written in the English language, related to radiculopathy, sciatica, and/or low back pain with leg pain, and that provided recommendations on oral medication. Methodology: The review was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta‐Analyses (PRISMA) and the protocol was pre‐registered with the International Prospective Register of Systematic Reviews (PROSPERO). Eligibility screening, full‐text review, extraction of information pertaining to pharmacological management, and synthesis of results were performed independently by two authors and a third investigator was recruited to arbitrate any disagreements. The AGREE II tool was administered by four authors to appraise CPG quality. Synthesis: After screening 413 citations and assessing 37 full‐text articles, 11 CPGs met the inclusion criteria. They represented seven countries (Belgium, Canada, England, France, Japan, Korea, and United States) and three continents (Asia, Europe, and North America), as well as the Global Spine Care Initiative aimed at a worldwide presence. The mean overall AGREE II score was 87.1% (standard deviation [SD] 12.6%), generally reflecting high‐quality CPGs. The highest domain mean score was for Clarity of Presentation (96.7%, SD 4.4%), and the lowest was Applicability (75.6%, SD 22.8%). Five classes of medications were recommended by at least one CPG: anticonvulsants, antidepressants, oral corticosteroids, nonsteroidal anti‐inflammatory drugs (NSAIDs), and opioids. Conclusions: The most common medication class recommended by the CPGs for lumbar radiculopathy was antidepressants. No CPGs recommended prescribing acetaminophen, benzodiazepines, muscle relaxants, or antibiotics. There was very little agreement between the CPGs, and all the medication classes had at least one CPG recommended against its use. Three guidelines reviewed did not recommend any medications due to lack of supporting literature, and instead recommended nonpharmacologic therapy. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article discusses exertional compartment syndrome (ECS), a condition characterized by muscle pain during activity and relief with rest, particularly in the lower extremities. The exact cause of ECS is unclear, but it is believed to be related to increased compartment pressure and decreased blood flow. Diagnosis of ECS is confirmed through compartment pressure measurements (CPMs), although the protocols and criteria for diagnosing ECS are imprecise. Treatment options for ECS, such as fasciotomy or activity modification, are not clearly defined, and outcomes can vary. The article highlights the potential role of abnormal hip motions in contributing to ECS and emphasizes the importance of clinical history and physical examination in recognizing the condition. [Extracted from the article]

Exertional leg pain is a common problem in the athletic population, presenting with a constellation of similar symptoms. Delayed or incorrect diagnosis and treatment may result in significant morbidity and avoidable cessation of activity. Multiple causes such as chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), nerve or vascular entrapment syndromes may be responsible. A thorough history and focused clinical examination is mandated, and may yield clues as to the definitive diagnosis. Investigative adjuncts include imaging, compartment pressure measurement and electrodiagnostic studies. Whilst specific management depends on the underlying cause, the mainstay of initial management is activity modification, with surgery reserved for those who fail to respond to conservative measures. [ABSTRACT FROM AUTHOR]

Background: Exercise‐related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners; however, there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP. Objective: To compare ultrasound‐derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP. Design: Cross‐sectional design. Setting: Hospital‐affiliated sports injury prevention center. Participants: Twenty‐eight adolescent runners with (N = 14) and without ERLLP (N = 14). Interventions: Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures. Main Outcome Measures: Separate repeated measures multivariate analyses of covariance (covariate: gender) were used to compare groups and limbs for mass‐normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles. Results: The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: −0.12–0.49 mm/kg; p range:.002–.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: −3.7–6.4°; p <.001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: −0.14–−0.15 mm/kg; p range:.02–.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: −18; p =.02). Conclusions: Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. The findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening. [ABSTRACT FROM AUTHOR]

Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Recurrent fever, serositis, and arthritis are common findings of the disease. In addition, musculoskeletal complaints such as exertional leg pain can be overlooked, although they are common and affect patients' quality of life. The aim of this study was to evaluate the frequency of exertional leg pain in pediatric FMF patients and to analyze the association of this finding with other characteristics of FMF The files of FMF patients were retrospectively evaluated. The clinical characteristics and disease severity of the patients with exertional leg pain were compared with the patients without exertional leg pain. International severity scoring system for FMF (ISSF) and Mor severity score were used for assessment. The study included 541 FMF patients (287 females), 149 (27.5%) with exertional leg pain. The median colchicine dosage was significantly higher in patients with exertional leg pain (p = 0.02), arthritis (p = 0.001) and arthralgia (p˂0.001) were encountered more frequently in the attacks of these patients. The median disease severity scores calculated by both Mor severity scale and ISSF were significantly higher in patients with exertional leg pain compared to those without (p˂0.001). In the group of patients with exertional leg pain, the M694V mutation, either in one allele or in two alleles, was found to be significantly more common (p = 0.006 and p˂0.001, respectively). Exertional leg pain in pediatric FMF patients is the component of moderate-to-severe disease course, and this may be considerably associated with the presence of M694V mutation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between children's pain/distress levels and patient characteristics (age, sex, history of dental pain), sedation type (level of sedation, sedative regimen), nociception and pain intensity reported by the parents in sedated children undergoing minimally invasive dental treatment. Methods: This clinical study evaluated secondary outcomes of an RCT that evaluated the efficacy of dexmedetomidine sedation with or without ketamine. Only children who had nociception levels recorded using the Analgesia Nociception Index (ANI) were included (0–100; 0 = highest nociception). FLACC scale (Face, Legs, Activity, Cry and Consolability) was used to assess children's pain/distress (0–10; 0 = no pain/distress). Parental proxy report of the child's pain intensity during the treatment was performed using the Visual Analogue Scale (VAS; 0–100; 0 = no pain). The association between ANI, children's age and sex, dental pain history, sedation level, sedative regimen, and VAS with the FLACC was verified using the generalised estimation equation analysis (alpha 0.05). Results: Participants were 31 children (51.6% boys) and their parents (90.3% mothers). Median FLACC was 3.3 (25th–75th percentiles 1.7–8.2), ANI 80.9 (74.7–85.8), and VAS 10 (1–23). FLACC associated with ANI (OR 0.96; 95% CI 0.93–0.99; p = 0.02), moderate sedation (0.13; 0.03–0.50; p = 0.003), and VAS (1.05; 1.01–1.10; p = 0.01). Conclusion: Pain/distress was generally low and more prominent with minimal (versus moderate) sedation and higher nociception. [ABSTRACT FROM AUTHOR]

As noted by Turnipseed ([11]) in a large case series of patients with exertional leg pain, anatomic PAES patients are more likely to be older, male, and have lower levels of activity. In the 614 patients seen from 2000 to 2007, 141 patients tested positive for popliteal entrapment but 121 had no obvious symptoms of FPAES and therefore only underwent compartment release. Diagnosis of FPAES can be difficult because of the overlap of symptoms with other causes of exertional lower leg pain, such as medial tibial stress syndrome, bone stress injury, and particularly chronic exertional compartment syndrome (CECS). Entrapment screening studies were positive in all FPAES patients and 24% of the patients with superficial posterior CECS. [Extracted from the article]

Background: Post-partum period brings joy as well as pain for women. It is period after delivery till 42 days. In most of women, problems like leg pain, back pain, floppiness of abdominal muscles, edema and extremities, spinal problems, problems in breast feeding arise. Postnatal back pain including lumbosacral region, pelvic girdle and sacroiliac pain is very common presentation. Evidences show that post natal low back pain is very common. Various studies show that in first year after delivery it ranges from 21% to 82%. It also has on and off period. Re-occurrence of pain is seen in first 6 months. In caesarean section, 51% of women noticed pain back by 1 month and 78% by 6 months. In vaginal delivery it reoccurred in 55% women at 1 month and 85% in 6th month. Conventional physiotherapy interventions are worldwide accepted one and practiced on large scales in various circumstances. Conventional approaches for back pain which includes core muscle exercises, yogic postures, walks, runs, hydrotherapy exercises and cardiorespiratory fitness training. Role of physiotherapy for women’s health is an upcoming area in developing country like India. It needs to be evaluated in both rural and urban set ups. Method: 494 subjects fulfilling inclusion and exclusion criteria were included. Conventional training was given for 6 weeks. Outcome measures used were focusing on Pain (Visual Analogue Scale), Range of motion (Modified Schober Test), abdominal muscle strength (Manual Muscle Testing) and quality of life (Oswestry Low Back Disability). Result: Student t-test was used for statistical analysis. The results showed significant changes in all the outcome measures but was time consuming lacked in establishing confirm evidences. Conclusion: Conventional therapy reduced back pain and improved quality of life but was time constrained. Further evaluation needs to be done for better results. [ABSTRACT FROM AUTHOR]

Background: Myxopapillary ependymomas (MPEs) possess leptomeningeal, neural axis dissemination, seeding metastases, and extra-neural spread which are malignant characteristics, even they classified low-grade lesions as WHO grade II. Managing such lesions remains an arguable neurosurgical challenge. The study aimed to discuss the management of MPEs by evaluating the long-term surgical outcomes of consecutively treated MPEs in different 3 neurosurgical centers. Methods: Medical records of all diagnosed patients with spinal tumors at our institutions were reviewed retrospectively. This study included all consecutive MPE who underwent surgical intervention in our institutions in different periods between February 2004 and December 2020. Results: A total of 44 patients with MPE were treated surgically in three institutions. 28 (63.6%) patients were males. Six patients were pediatric patients (≤18 years). The mean age was 36.2 years. The preoperative course was 19.2 months. The most common symptom was leg pain, observed in 35 (79.5%) patients. Gross-total resection was performed in 35 (79.5%) patients. 39 (88.7%) patients had good functional outcomes with an average follow-up period of 106.2 months. The progression was observed in 5 (11.4%) patients. Extending >2 segments, unclear boundaries, bone-erosions were associated with poor prognosis and progression. Laminectomy and surgical complications were associated with poor functional outcomes. En bloc resection without violation of lesions' integrities reduced the progression. Conclusions: Radiological, intraoperative, and surgical factors can affect the functional outcomes and the progression of MPEs. Some precautions in the surgical interventions particularly in MPEs with defined radiological features can improve functional outcomes and reduce the progression risk. [ABSTRACT FROM AUTHOR]

In a 10-year retrospective PAES study (24 patients; 27 limbs) approximately half of cases had abnormal static DUS, though dynamic DUS was positive in all patients ([14]). Popliteal artery entrapment syndrome (PAES) is a rare progressive vascular disease. HT

Introduction: Pelvic girdle pain (PGP) is the most common musculoskeletal concern in pregnancy. The Active Straight Leg Raise (ASLR) test is diagnostic. Sacroiliac joint (SIJ) belts are included in multimodal therapy, but there is no established predictive measure to determine which pregnant women will benefit. Objective: To determine if the ASLR score is immediately reduced by SIJ belt application and whether PGP pain and function improves after 4 weeks of belt use. Design Prospective observational cohort study. Setting: Academic medical center. Participants: Pregnant women at least 18 years of age in the second or third trimester of pregnancy with posterior PGP and ASLR score of 2 to 10. Interventions: Four‐week SIJ belt use. Main Outcome Measures: ASLR, Numerical Rating Scale (NRS), Pelvic Girdle Questionnaire (PGQ), Perceived Global Impression of Improvement (PGII). Results: Sixty‐three women enrolled. On multivariable analysis, immediate belted ASLR score was −2.70 points lower than the non‐belted ASLR score (P <.001). Four weeks later there was significant improvement in the ASLR score with a belt (Mdiff = −0.99; P =.001) and without a belt (Mdiff = −1.94; P <.001); the decline was more precipitous for the non‐belted response (Mdiff = −0.96; P =.02). Current NRS pain scores declined from baseline by approximately −0.94 points (P <.001). This decline did not depend on ASLR scores (interaction P =.43) or wearing a belt at the time of testing (interaction P =.51). Similar conclusions held for participants' usual NRS score and average PGQ score. After 4 weeks, 82% reported improvement based on the PGII. Conclusions: SIJ belts are a safe, well‐tolerated, and effective therapeutic option for pregnancy‐related PGP. The ASLR score is immediately reduced following SIJ belt application but does not predict pain score 4 weeks later. SIJ belt leads to significant improvements in pain and function over time. [ABSTRACT FROM AUTHOR]

Background: Chronic exertional compartment syndrome (CECS) is a type of leg pain related to elevated intracompartmental pressure with activity in one or more of the four compartments of the leg. Open fasciotomy is the definitive treatment for CECS but has a reported complication rate of up to 15.7% and return to full activity reported up to 16 weeks. Ultrasound‐guided (USG) fasciotomy of the anterior and lateral compartments has been translated into clinical practice. Objective: To determine the safety and feasibility of a USG fasciotomy of the deep posterior compartment (DPC) and superficial compartment (SPC) of the leg in a fresh‐frozen cadaveric model. Design: Prospective, cadaveric laboratory investigation. Setting: Procedural skills laboratory at an academic institution. Cadaveric Cohort: Ten fresh‐frozen cadaveric knee‐ankle‐foot specimens from five female and five male donors aged 58 to 93 years (mean 77.4 years) with body mass indexes of 18.1 to 33.5 kg/m2 (mean 25.1 kg/m2). Methods or Interventions: One experienced operator performed 10 USG DPC and SPC fasciotomies. A clinical anatomist performed dissections of each. Main Outcome Measures: Achievement of target length and continuity of release was recorded. Target lengths of 10 cm for the superficial posterior compartment (SPC) and 15 cm for the deep posterior compartment (DPC) were established based on previous studies. Tendinous and neurovascular structures were assessed for damage. Results: No tendon or neurovascular injuries were observed. In the SPC, target length was achieved in 90% and continuous release was observed in 80%. In the DPC, target length was achieved in 60% and continuity observed in 30%. Conclusions: These findings suggest that SPC USG fasciotomies using the technique described in this study are feasible, may be safe, and warrant further translational research; however, DPC USG fasciotomies are more challenging and require more technical refinement prior to clinical translation. [ABSTRACT FROM AUTHOR]

Aim: The current investigation was to examine the intensity of body discomfort and various musculoskeletal disorders experienced by painter community due to their occupational habitat. Methods: A questionnaire was developed systematically with high competence with the current standard, which includes general profile sheet, occupational profile sheet and a modified Kromers body discomfort scale (Kroemer et al., 1987). These tools were used to gather information from the respondents. A sample of fifty two male painters aged between 19-75 years were interviewed randomly and mined various socio-demographic, socio-economic and health information. Data on occupational history, accidents, and leisure time activities were also collected. This paper focused on the intensity of pain due to prolonged standing and other postures during painting activities. Result: The prevalence of occupational health hazards has been reported to be high among painter community in India. The study revealed that the painters were engaged in rigorous hand-intensive jobs for many years, this subsistence activity led to rigorous and permanent discomforts in different parts of their body as an occupational health hazards. Conclusion: From the findings of the study, it can be concluded that painters faced many occupational health hazards. The current study focused on musculoskeletal disorder and uncertainties due to the nature of high risk associated painting jobs. The study revealed that the painter's communities were highly susceptible to musculoskeletal disorders, especially severe leg pain. Most of the interviewed painters were highly concerned about high risk areas (activities on scaffoldings). So for safeguarding the painter communities from high potential professional, physical and physiological health risk, the government must entrust contractors for providing standard and modernized safe working environment, safeguarding tools and risk incentives. [ABSTRACT FROM AUTHOR]

We aimed to compare the clinical and radiological outcomes of midline lumbar fusion (MIDLF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery. Consecutively treated patients with lumbar pathology who underwent MIDLF (n = 16) and a historical control group who underwent MI-TLIF (n = 34) were included. Clinical symptoms were evaluated using Oswestry Disability Index (ODI), the 36-Item Short-Form Health Survey, and visual analog scale (VAS) scores before surgery and 3, 6, 12, and 24 months after surgery. The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min vs. 229 min, P < 0.001; 0.34 vs. 0.36, P = 0.037). The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively. VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months. At 24 months follow-up, VAS back pain was higher in MI-TLIF than in MIDLF cases (P = 0.018). MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates, and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis. [ABSTRACT FROM AUTHOR]

Chronic exertional compartment syndrome (CECS) is one of the wide range of causes of exercise-related leg pain in athletes. It is defined as a transient increase in compartment pressures during activity, which causes pain, because of the inability of the fascial compartments to accommodate and is usually relieved by cessation of exercise. Exercise-induced leg pain in the athletic population is a common complaint, with reports of up to 15% of all runners arriving to initial evaluation with this presentation. Often, this lower-extremity exertional pain is grouped into the common term of "shin splints" by athletes, which is a nondiagnostic term that implies no specific pathology. It may, however, encompass much of the differential for CECS, including medial tibial stress syndrome, muscle strain, and stress fracture. Improving diagnostic techniques, as well as treatments, will continue to help athletes and patients with leg pain in the future. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess changes in pain and physical activity after replacing a traditional spinal cord stimulation (SCS) implantable pulse generator with a next generation SCS in patients for whom traditional SCS was no longer providing adequate relief of low back and/or leg pain. Subjects (n = 19) who reported that they were no longer receiving adequate relief from traditional SCS were implanted with a next generation SCS. Eighteen additional patients who were receiving relief from traditional SCS were also followed as a control. Both groups (next generation, traditional) were assessed for low-back and limb pain (visual analog scale) and daily physical activity (wearable accelerometer) at baseline and three, six, nine and 12 months following the SCS implant. Relative to baseline, next generation SCS subjects exhibited reductions (p = 0.05 for all) in low-back pain (average reduction of 22%) at every time point, in leg pain (average reduction of 23%) at every time point except six months and increased physical activity (average increase of 57%) at three, six and nine months. As expected, there were no changes in pain or physical activity in the traditional SCS subjects (p = 0.1). In conclusion, pain decreased, and physical activity increased in patients receiving a next generation SCS. Physical activity may serve as an objectively measured marker of pain. [ABSTRACT FROM AUTHOR]

Le syndrome de loge chronique, défini par une augmentation pathologique de la pression intramusculaire à l'effort, est couramment diagnostiqué grâce à la mesure de pression intramusculaire, et est réalisée le plus souvent au niveau de la jambe. Cette technique, initialement décrite par Whitesides, fut nettement améliorée ces dernières années, et s'effectue actuellement par l'utilisation d'un moniteur de pression à affichage digital. Les mesures sont effectuées au sein de la loge douloureuse, au repos, puis après un effort physique permettant de reproduire la douleur maximale ressentie par le patient. Même si aucun consensus n'existe à l'heure actuelle, les valeurs seuil les plus utilisées sont celles reprenant les critères de Pedowitz. Cependant, ces mesures doivent être associées à d'autres examens complémentaires (IRM, écho doppler dynamique, mesure de l'Index de Pression Systolique,...) afin d'éliminer un éventuel diagnostic différentiel (syndrome d'artère poplitée piégée le plus souvent). De plus, ces mesures peuvent parfois s'avérer faussement négatives, et doivent donc être confrontées à l'histoire médicale et à un examen clinique complet et rigoureux. The diagnosis of chronic exertional compartment syndrome is usually carried out by the increasement of intramuscular pressures, more often in the lower limb after an exercise. This technique, initially described by Whitesides, has been significantly improved in recent years, and is currently carried out using a digital display pressure monitor. Measurements are performed within the pain compartment, at rest, and after physical exercise to reproduce the maximum pain felt by the patient. The most used threshold values are those using the Pedowitz criteria. However, these measurements have to be associated with other complementary examinations (MRI, dynamic Doppler, Ankle Brachial Index measurement..) in order to eliminate a differential diagnosis (most often popliteal artery entrapment syndrome). In addition, measures can sometimes be false negative, and must therefore be confronted with medical history and a thorough and rigorous clinical examination. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Exertional leg pain is a common and disabling condition in athletes with challenging diagnosis and management. We report the case of a 29-year-old rugby player with a history and clinical examination consistent with chronic exertional compartment syndrome (CECS). Compartment pressure measurement was supportive of the diagnosis. However, magnetic resonance angiography (MRA) with provocative maneuvers showed functional popliteal artery entrapment syndrome (PAES). For the treatment of CECS, bilateral fasciotomy of the anterolateral compartments permitted return to full sport participation in 8 weeks. A follow-up MR angiogram at 12 months showed resolution of the popliteal entrapment leading us to hypothesize a possible relationship between CECS and functional PAES. [ABSTRACT FROM AUTHOR]

Objectives: Endofibrosis was first described in endurance athletes. This rare disease is characterized by intimal hyperplasia of iliac arteries. Due to non-specific symptoms diagnosing could be very challenging and delayed. This represents a serious problem not only for affected athletes but also for consulting physicians. The aim of this study was to analyze intimal thickness of iliac arteries using non-contrast magnetic resonance imaging (MRI) in competitive triathletes suffering from exercise induced leg pain consistent with symptoms caused by endofibrosis. Methods: 18 highly trained triathletes (16 triathletes, 12 male) with a mean age of 45.4 ± 10.2 years were investigated by non-contrast MRI. We divided subjects into two groups: 10 complaint about exercise- induced leg pain and 7 were free of any symptoms. In all 10 symptomatic athletes consulting physicians excluded musculoskeletal or neurological disorders before and we suspected endofibrosis. One patient was excluded from statistical analysis due to a known recurrent external iliac artery (EIA) occlusion after surgical repair 6 month ago. Results: Mean wall thickness (T) of all 17 subjects was 1.34 ± 0.11mm for the common iliac artery (CIA) and 1.74 ± 0.18mm for the EIA. We found no significant differences by comparing T of symptomatic (s) and asymptomatic (a) legs. There were no significant differences in mean ratio of patent artery to whole artery between the symptomatic and asymptomatic legs for the CIA (0.81 vs 0.82, p = 0.87) and for the EIA (0.71 vs 0.72, p = 0.78). MRI shows a thickening of the left EIA (4.41mm) in the patient who suffered from recurrent occlusion of the left EIA and after surgical repair and histological examination confirmed an endofibrotic lesion. Conclusion: Non-contrast MRI seems to be an appropriate diagnostic tool to exclude endofibrosis in triathletes, but it cannot be recommended as initial screening modality for athletes suffering from exercise-induced leg pain. [ABSTRACT FROM AUTHOR]