Stress-Related Anterior Lower Leg Pain: Evaluation with MRI and Intracompartmental Pressure Measurement

Kiuru MJ,^1,2 Mäntysaari MJ,¹ Pihlajamäki HK,³ Ahovuo JA²

1. Research Institute of Military Medicine, Helsinki, Finland

2. Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland

3. Department of Surgery, Central Military Hospital, Helsinki, Finland

Purpose: To assess the feasibility of MRI and anterior tibial compartment pressure measurement in evaluating the causes of stress-related anterior lower leg pain.

Materials and Methods: This series was composed of 24 consecutive conscripts suffering from stress-related, anterior, lower leg pain. Twenty patients had bilateral symptoms. The patients underwent clinical examination, MR imaging, and intra-compartmental pressure measurement. The intracompartmental pressure was measured in the anterior tibial compartment using a standardized protocol. Intra-compartmental pressure values higher than 40 mmHg were considered pathological.

Results: As compared with the intracompartmental pressure measurement, 50% of the patients had a false-positive clinical diagnosis of chronic exertional compartment syndrome (CECS). The duration of symptoms was longer in the patients with CECS than in those without (p <0.01). MR imaging revealed abnormal findings in 35 symptomatic legs, the remaining 9 symptomatic legs were normal. In 33 legs, there was a stress fracture, and two legs had traction periostitis. There were no significant differences in the bone findings between the patients with CECS and those without (p >0.05).

Conclusions: Stress-related anterior lower leg pain may result from CECS, stress fracture, and traction periostitis. The clinical diagnosis is not reliable. CECS and stress fracture or traction periostitis may occur separately or simultaneously.

Keywords: compartmental pressures; leg; MRI; pain; periostitis; stress fractured

Prehosp Disast Med 2002;17:s???.