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Title: The diagnosis and management of chronic exertional compartment syndrome in the UK military population
Author: Roscoe, David
Awarding Body: University of Surrey
Current Institution: University of Surrey
Date of Award: 2016
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Background Chronic Exertional Compartment Syndrome (CECS) presents as exertional pain in the lower limb presumed to be a result of elevated intramuscular compartment pressure (IMCP) although this has never been proven. Doubt exists regarding the validity of the diagnostic criteria for CECS, the role of IMCP and the outcomes from surgical management. An alternative biomechanical condition, Anterior Biomechanical Overload Syndrome (ABOS), was proposed to account for the symptoms of CECS and a programme of gait re-education (GRE) was introduced although no primary research has been carried out to investigate the predisposing biomechanical and anthropometric factors for CECS. Methods Case-control studies investigated the anthropometric, biomechanical and IMCP differences between CECS cases and asymptomatic controls. A post-surgical study evaluated the role of IMCP and a longitudinal study investigated the effectiveness of GRE and the nature of resultant biomechanical changes. Results Cases were significantly shorter than controls with increased plantarflexion at toe off and an increased rate of plantarflexion after heel strike. IMCP levels were significantly higher in cases than controls allowing for the extraction of diagnostic criteria for CECS. Surgical responders had similar IMCP to controls but significantly lower IMCP than non-responders. The biomechanical symptoms of ABOS were not replicated. GRE made changes to gait but these did not correspond to those identified in the CECS case-control study. Conclusions The intrinsic role of IMCP in CECS has been confirmed allowing for improved diagnostic criteria. Use of these criteria should allow for improved patient selection for surgery and improved outcomes for CECS. Novel insights to the biomechanical and anthropometric differences are provided allowing for the proposal of a new pathophysiological model whereby extrinsic training conditions impact upon intrinsic risk factors leading to CECS. These studies do not support the existence of ABOS or the use of GRE in the management of CECS.
Supervisor: Hughes, Michael P. ; Shaheen, Aliayah Sponsor: Defence Postgraduate Medical Deanery
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available