Zusammenfassung
Bei einem kleinen Anteil der Patienten mit belastungsinduziertem Beinschmerz liegt ein tiefes posteriores chronisches Belastungskompartmentsyndrom (deep posterior chronic exertional compartment syndrom [dp-CECS]) vor. Die Betroffenen geben Schmerz, Verkürzungen und Krämpfe tief in den Wadenmuskeln an, die durch körperliche Aktivität hervorgerufen werden, aber in geringerem Maße auch in Ruhe bestehen können. Die körperliche Untersuchung ergibt häufig eine schmerzhafte Palpation der Flexoren im Bereich unmittelbar dorsomedial zur Tibia. Die Diagnose wird mithilfe der intrakompartimentellen Druckmessung gesichert. Verschiedene Krankheitsentitäten können sich ähnlich präsentieren oder mit dem tp-CBKS zusammenfallen, so etwa das Schienbeinkantensyndrom und das Popliteakompressionssyndrom. Die Fasziotomie mehrerer Flexoren ist die einzige Therapieoption mit positivem Behandlungsergebnis. In der vorliegenden Übersicht werden Diagnose und Therapie des tp-CBKS diskutiert.
Abstract
A small proportion of patients with exertional leg pain (ELP) have deep posterior chronic exertional compartment syndrome (dp-CECS). These individuals report pain, tightness and cramps deep in the calf muscles that are elicited by exercise, but may also be present during rest to a lesser extent. Physical examination often reveals painful palpation of the flexor muscles in the area immediately dorsomedial to the tibial bone. Diagnosis is confirmed by intracompartmental pressure testing. Various entities may mimic or coincide with dp-CECS, including medial tibial stress syndrome (MTSS) and popliteal artery entrapment syndrome (PAES). Fasciotomy of multiple flexor muscles is the only treatment that achieves a beneficial outcome. The aim of this overview is to discuss the diagnosis and management of dp-CECS.
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M. Winkes, P. van Eerten und M. Scheltinga geben an, dass kein Interessenkonflikt besteht.
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M. Scheltinga, Veldhoven, NL
P. van Eerten, Veldhoven, NL
Die englische Version dieses Beitrags ist unter https://doi.org/10.1007/s00113-019-0665-1 zu finden.
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Winkes, M., van Eerten, P. & Scheltinga, M. Tiefes, posteriores chronisches belastungsinduziertes Kompartmentsyndrom als Ursache von Beinschmerz. Unfallchirurg 122, 834–839 (2019). https://doi.org/10.1007/s00113-019-0664-2
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DOI: https://doi.org/10.1007/s00113-019-0664-2