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Exertional Compartment Testing

Dr. Marc Silberman specializes in compartment pressure testing for exertional compartment syndrome and the diagnosis of exertional leg pain. He has been performing compartment tests for more than 20 years and is a referral source for orthopedic surgeons located throughout the United States and abroad.  Exertional compartment pressure testing is performed under ultrasound guidance ensuring proper location.  Dr. Silberman has standardized the ultrasound guided exertional compartment syndrome pressure test published here.  He has presented cases at national conferences and has been published in peer-reviewed scientific journals on the topic of exertional compartment syndrome. Compartment testing of the forearm can also be done.













Differential Diagnosis of Exertional Leg Pain:

Exertional Compartment Syndrome, Popliteal Artery Entrapment, Stress Fracture, 'Shin splints',
Medial Tibial Stress Syndrome, Nerve entrapment, Arterial entrapment, Spinal radiculopathy, Calf strain,
Iron Deficient Anemia, Thalassemia, Lyme Disease, Epstein Barr Virus (Mono), Deep Venous Thrombosis (DVT), Medication induced leg pain.

Yes, we have seen athletes travel, spend thousands of dollars on imaging told was needed and then thousands of dollars on failed treatment, and with one blood test, Dr. Silberman diagnosed iron deficient anemia or with one change of medication, leg pain was cured.

Exertional Compartment Syndrome:

Exertional compartment syndrome is a clinical condition where an athlete or active individual experiences exercise or activity induced lower leg pain that is relieved with cessation of exercise.  There may be numbness, tingling, swelling, tightness, and weakness.  The presentation of exertional compartment syndrome is quite variable despite what you may read and pain may be present all the time even after cessation of exercise.  Despite prolong rest, the symptoms rapidly come back with resumption of exercise.  Frustrating, there is often a delay to diagnosis with multiple doctor specialist visits and thousands of dollars spent on work up and treatment before a correctly performed compartment test is performed by Dr. Silberman at New Jersey Sports Medicine.

The exact cause of exertional compartment syndrome is unknown though the symptoms are felt to be secondary to excessive pressure within the compartments causing compression of nerves and blood vessels.

Diagnosis of exertional compartment syndrome is made by  performing a compartment test before and after exercise, the gold standard and only test scientifically validated to diagnose exertional compartment syndrome, Pressures normally rise with exercise but should return to baseline within 5 minutes after cessation of running.  In exertional compartment syndrome, markedly elevated pressures result and remain elevated for a prolonged length of time.

Expensive and cancer causing CT Scan imaging are not only harmful but are not indicated for exertional compartment syndrome diagnosis or treatment.  There is not one study validating the use of CT Scan for the diagnosis and treatment of exertional lower leg compartment syndrome in the scientific literature.  CT Scans
give off ionizing radiation and children are more radiosensitive than adults, with a positive association of radiation dose and development of leukemia and brain cancer.

Exertional Compartment Syndrome Pressure Test:

Your skin is anesthetized with lidocaine.  A manometer, as imaged above in the anterior compartment, is inserted four separate times into each leg to measure the four compartments of your lower limb under ultrasound guidance at rest and then post exercise to symptoms.  If pressures are markedly elevated at rest, exertion
need not be performed.

At the same time as the compartment test, Dr. Silberman, a specialist in diagnostic ultrasound, will measure the size of your compartments pre- and post exercise using ultrasound, as those with exertional compartment syndrome have
been found to have enlarged compartment swelling with exercise that may be treated with medications.

All athletes with exertional leg pain and a presumptive diagnosis of exertional compartment syndrome, may also undergo a separate vascular screening test, an ankle brachial index (ABI) treadmill stress test as well by Dr. Silberman.  We have seen many cases of failed compartment syndrome fasciotomies in athletes
who were later diagnosed by Dr. Silberman to have had popliteal artery entrapment syndrome.

Treatment of exertional compartment syndrome that are often tried but fail include: modification of activity, addressing training error, orthotics, video gait analysis and run form training, massage, myofascial release, and physical therapy.  Once you develop exertional compartment syndrome though, it appears the only treatment option until recently has been surgery, fasciotomy which has a greater than 50% failure rate.

Botox injections for exertional compartment syndrome is a novel, non-surgical intervention that has promising results in published case studies, first reported in 2008 by Isner-Horobeti.  Dr. Silberman was one of the first physicians to treat exertional compartment syndrome with botox and now instructs other physicians how to perform injections under ultrasound guidance.

If you are a candidate for botox injections, after consultation, the amount of Botox for your treatment of exertional compartment syndrome and/or popliteal artery entrapment is calculated and a prescription for Botulinum Toxin Type A (Botox) will be given to you to be filled at a pharmacy.  Botox injections for compartment syndrome are not covered by insurance.  More than one treatment session may be needed.

Dr. Silberman is regularly contacted by athletes and frustrated individuals from around the country and world, who have spent thousands of dollars on radiology studies and treatment that did not work.  We embrace hearing from you and though Dr. Silberman may not be able to speak to every one of you, someone from the office will speak to you and Dr. Silberman can review your records.


Click to learn more about botox injections for exertional compartment syndrome.

Could some cases of exertional compartment syndrome be a muscle disease?
If you want to learn something new, read something old:

Ultrasound of the anterior compartment in exertional compartment syndrome (1982)

Evidence for low muscle capillary supply as a pathogenesis in chronic compartment syndrome (2009)

Stiffness and Thickness of Fascia Do Not Explain Chronic Exertional Compartment Syndrome (2011)

Muscle Function in Chronic Compartment Syndrome of the Leg (1993)

Recurrent Compartment Syndrome Leading to the Diagnosis of McArdle Disease


Silberman, Marc R., Brian J. Shiple, and Steven J. Collina. "Exercise Induced Leg Pain-Soccer." MSSE
36.5 (2004):S93.

Getzin, Andrew R., and Marc Richard Silberman.  "Iliac Artery Flow Limitations in Endurance
Athletes." CSMR 9.6 (2010):334-337.

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