Multiple compart ments are affected in about half of chronic compartment syndrome cases and symptoms in the bilateral legs occur in approximately 75% of cases. Potential risks include muscular hernia or neurovascular damage. However, some problems exist: Pressure measurement is an invasive technique. The diagnosis of chronic exertional compartment syndrome requires measuring compartment pressure with a slit or weak catheter. Of the four lower leg muscular compartments, anterior and lateral compartments are affected more frequently than others (76%), followed by deep posterior (16%) and posterior superficial (12%).
It is caused by abnormally increased pressure within muscular compartments that are enclosed by relatively noncompliant fasciae. 5A, 5B ).Ĭhronic exertional compartment syndrome is a cause for claudication in athletes. However, sometimes CT permits the early diagnosis of cortical abnormalities not visible on MRI (Fig. MRI is the most sensitive single diagnostic tool for patients with medial tibial stress syndrome given its excellent soft-tissue contrast to show soft-tissue abnormalities (Figs. Both MRI and CT have high accuracy in detecting the spectrum of cortical abnormalities. The other cortical abnormalities and the majority of cortical fractures (up to 94%) remain undetected (Fig. Radiog raphy detects only a small number of cortical fractures.
1A, 1B ).Ĭortical lesions include osteopenia, cavitations, striations, and fractures. Often, on STIR or fat-saturated T2-weighted images, detached periosteum can be seen as a thin hypointensity surrounded by hyperintense edema (Fig. Periostitis appears as a soft-tissue edema near the cortex. Although a bone scan can be positive in this condition, MRI is the most sensitive examination for diagnosing periostitis. Periostitis can occur both as an isolated abnormality or in association with bone stress injuries. Although both proximal and distal metaphyses and the whole diaphysis can be involved by stress injuries, such injuries more frequently occur in the cortex of the distal two thirds of the tibia and cause a clinical syndrome known as medial tibial stress syndrome or shin splints. This spectrum of lesions includes periostitis, cortical osteopenia, cancellous bone, and cortical fractures, often associated with various degrees of reactive soft-tissue and bone marrow edema. Tibial stress injuries include various types of bone lesions that represent a continuum of abnormalities from asymptomatic osteopenia to fracture, all occurring in response to abnormal repetitive stress applied to normal bone. Tibial stress injuries are by far the most common cause of lower leg pain in athletes, accounting for up to 75% of exertional leg pain. The objectives of this article are to describe the imaging features in athletes with chronic lower leg pain, emphasizing the roles of MRI and CT, which are the diagnostic tools with the highest sensitivity and specificity in the differential diagnosis of lower leg pain, and to propose a diagnostic algorithm in patients with chronic lower leg pain. Consequently, the role of diagnostic imaging remains fundamental in detecting the cause of chronic lower leg pain. Īlthough a high index of suspicion, careful physical examination, and detailed history are essential in athletes with chronic lower leg pain, “even for an astute clinician, distinction between the different medical causes may be difficult given that many of their presenting features overlap”. The causes of chronic lower leg pain in the athlete are numerous, and therefore the differential diagnosis is quite broad (Appendix 1).Īccording to the literature, despite the wide range of potential diagnoses, medial tibial stress syndrome and stress fractures are the most common sources of exercise-induced chronic lower leg pain, followed by chronic exertional compartment syndrome and popliteal nerve entrapment. By definition, lower leg pain is pain between the knee and ankle. Exercise-induced chronic leg pain is a common condition in compet itive and recreational athletes.
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