SPECIAL COMMUNICATIONS: Team Physician Consensus Statement: Letters to the Editor-in-Chief
I read the article by Birtles et al. (2) and found the conclusion that chronic exertional compartment syndrome patients may have an increased sensitivity of pain receptors to be very interesting. We are finding an increasing number of patients with exercise-related leg pain that cannot be explained by conventional diagnosis. Perhaps these also are due to altered pain receptors.
However, my main reason for writing is that there has been a fundamental error of fact that is referenced back to me.
It is always gratifying to be referenced in someone else’s work, and in the case of this article my 1997 review article (1) has been mentioned no less than five times (albeit as Barnes B., rather than Barnes M.). Unfortunately, one of these has completely misrepresented what was published in the original article to the extent that a very dangerous mistake has been made.
For those who have not read my original article, there is a section on the clinical aspects of chronic compartment syndrome in which I describe some of the associated clinical signs and differential diagnosis. Swelling is discussed, and I state that it is no indication of raised compartmental pressure. I then go on to say:
“It is common to find grossly swollen and tense limbs with normal intracompartmental pressures (in patients with suspected acute compartment syndrome).”
This is why it is necessary to carry out intracompartmental pressure measurements because it is not always clear from signs and symptoms alone. Swelling can occur for many other reasons. The opposite can also be true, raised intracompartmental pressures can occur with no swelling (a common occurrence in the deep posterior compartment).
However, Birtles and her coauthors have completely misunderstood this statement by stating:
“It is also worth noting that the acute form of the syndrome is associated with pain and swelling but normal intramuscular pressure.”
This is simply not true. This is not really the forum to discuss the diagnosis of acute compartment syndrome, there are already many hundreds of publications on the subject, but the main fact of the matter is that raised intracompartmental pressure is the defining factor in an acute compartment syndrome. In their definitive book on the subject, Mubarak and Hargens (4) have described an acute compartment syndrome as a condition in which there is a build-up of pressure, within a closed osseofascial compartment, sufficient to reduce blood perfusion below a level necessary for tissue viability. Matsen’s definition (3) is very similar. This has been the universally accepted definition for the best part of 50 years. It is totally unacceptable to state, as in this paper, that acute compartment syndromes have normal intramuscular pressure. To implicate me as the source of this error only makes matters worse.
1. Barnes, M. Diagnosis and management of chronic compartment syndromes: a review of the literature. Br. J. Sports Med. 31: 21–27, 1997.
2. Birtles, D. B., D. Minden, S. J. Wickes, et al. Chronic exertional compartment syndrome: muscle changes with isometric exercise. Med. Sci. Sports Exerc. 34: 1900–1906, 2002.
3. Matsen, F. A. Compartmental syndrome an unified concept. Clin. Orthop. Relat. Res. 113: 8–13, 1975.
4. Mubarak, S. J., and A. R. Hargens. Compartment Syndromes and Volkmann’s Contracture. Philadelphia: WB Saunders, 1981.