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  • Funktionelles Kompartmentsyndrom

    Veröffentlich von Nicolai Völker on 9. Dezember 2022 at 5:55

    Hallo liebes PMS-Team, liebe Community,

    zurzeit habe ich eine Pat. mit einem funktionellen (chronischen) hinteren Kompartmentsyndrom in der Wade.

    Habt ihr hiezu vielleicht neueste Studienlagen bzw. Therapieansätze?

    Wie sieht es mit der Trainingsbelastung/Laufbelastung aus? Welche Empfehlungen kann ich der Patientin hier geben?

    Über euren Rat wäre ich euch sehr dankbar.

    Mit besten Grüßen

    Tobias Saueressig hat geantwortet vor 1 year, 7 months aktiv. 2 Mitglieder · 1 Antwort
  • 1 Antwort
  • Tobias Saueressig

    Mitglied
    10. Dezember 2022 at 10:03

    Hallo Nicolai,

    dazu vlt. Folgendes:

    “Nonoperative Management

    There is a lack of robust evidence illustrating the effectiveness of non-operative

    management of CECS in the general population [9]. However, some patient populations may

    benefit from a trial of non-surgical treatment. Diebal et al studied running techniques and their

    effect on pain and disability in CECS [16]. In a case series, they prospectively enrolled ten

    hindfoot striker runners who had CECS in the anterior compartment of the leg. Instead of surgical treatment, the patients underwent 6 weeks of forefoot running training. Resting and

    postrun compartment pressures, kinematic and kinetic measurements, and self-report

    questionnaires were taken before and after 6 weeks of training. Results showed a statistically

    significant (p < 0.05) decrease in mean post-run anterior compartment measurements from 78.4

    mmHg to 38.4 mmHg after forefoot running training. Running distance also saw statistically

    significant increase from 1.4 km before intervention to 4.8 km after intervention. Self-reported

    pain scores were lower and two-mile run times were significantly faster after intervention. Pain

    and disability remained reduced for up to 1 year, and surgery was avoided in all the patients.

    Adopting a forefoot strike while running was shown to be an effective conservative

    treatment strategy in runners[17]. In a prospective cohort study, 19 runners with CECS were

    enrolled in two intervention arms: supervised, center-based program and a home-based training

    program. Both groups received forefoot running training for six weeks and intra-compartmental

    pressure (ICP) measurements were performed at rest and post-run. Results showed a statistically

    significant increase in running distance, decrease in ICP values, and decrease in pain scores after

    intervention. There was no difference in outcomes between patients with a more supervised,

    center-based training program and less supervised, home-based training program.

    Botulinum toxin A injection has been described as a novel treatment for anterior or

    anterolateral chronic exertional compartment syndrome of the leg. [18]. One group of researchers

    injected Botulinum toxin A in a total of 25 anterior leg compartments and 17 lateral

    compartments in 16 patients with CECS. Intramuscular pressures were measured before the

    injection and 3-9 months after injection. Results showed a statistically significant decrease in

    compartment pressures in the anterior (63%) and lateral (68%) compartments. Ninety-four

    percent of the patients saw complete elimination of pain for up to 9 months. The most common

    Downloaded by [Australian Catholic University] at 02:11 28 September 2017

    side effect was loss of muscle strength. In 69% of the patients, strength decreased from 4.5 out of

    5 to 3.5 (P<0.01) without loss of functionality, which the authors defined as physical and sports

    performance.

    Based on these results, runners and patients with anterior and lateral CECS of the leg

    comprise a special population of patients in whom conservative treatment may be considered

    before surgical release [18].”

    aus: https://pubmed.ncbi.nlm.nih.gov/28952402/

    Generell gibt es leider keine gute Evidenz zu dem Thema….. Die Läufer in der oberen Studie hatten ein anteriores CS. Also nicht ganz übertragbar.

    LG Tobias

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