Botox for compartment syndrome in the leg

NewsBot · Aug 23, 2013

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Intramuscular Pressure Before and After Botulinum Toxin in Chronic Exertional Compartment Syndrome of the Leg
A Preliminary Study
Marie-Eve Isner-Horobeti et al
Am J Sports Med August 22, 2013 0363546513499183

Background: Botulinum toxin A (BoNT-A) is used in the treatment of muscle hypertrophy but has never been used in chronic exertional compartment syndrome (CECS). The objective diagnostic criterion in this condition is an abnormally elevated intramuscular pressure (IMP) in the compartment. In this study, the IMP was measured 1 minute (P1) and 5 minutes (P5) after the exercise was stopped before and after BoNT-A injection.

Hypothesis: Botulinum toxin A reduces the IMP (P1 and P5) and eliminates the pain associated with CECS.

Study Design: Case series; Level of evidence, 4.

Methods: Botulinum toxin A was injected into the muscles of moderately trained patients with an anterior or anterolateral exertional compartment syndrome of the leg. The BoNT-A dose (mean ± SD) ranged from 76 ± 7 to 108 ± 10 U per muscle, depending on which of the 5 muscles in the 2 compartments were injected. The primary end point was IMP (P1, P5). Secondary end points were exertional pain, muscle strength, and safety. Follow-up was conducted up to 9 months.

Results: A total of 25 anterior compartments and 17 lateral compartments were injected in 16 patients. The time interval (mean ± SD) between the BoNT-A injection and after BoNT-A injection IMP measurement was 4.4 ± 1.6 months (range, 3-9 months). In the anterior compartment, P1 and P5 fell by 63% ± 17% (P < .00001) and 59% ± 24% (P < .0001), respectively; in the lateral compartment, P1 and P5 fell by 68% ± 21% (P < .001) and 63% ± 21% (P < .01), respectively. Exertional pain and muscle strength were monitored, based on the Medical Research Council score. The exertional pain was completely eliminated in 15 patients (94%). In 5 patients (31%), the strength of the injected muscles remained normal. In 11 patients (69%), strength decreased from 4.5 (out of 5) to 3.5 (P < .01), although without functional consequences. In the conditions of this study, BoNT-A showed a good safety profile in patients with CECS.

Conclusion: In this case series, BoNT-A reduced the IMP and eliminated exertional pain in anterior or anterolateral CECS of the leg for up to 9 months after the intervention. The mode of action of BoNT-A is still unclear. A randomized controlled study should be carried out to determine whether BoNT-A can be used as a medical alternative to surgical treatment.
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Admin2 · Aug 23, 2013

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Chronic Exertional Compartment Syndrome

NewsBot · Sep 19, 2018

Botulinum Toxin as a Novel Treatment for Chronic Exertional Compartment Syndrome in the U.S. Military
Wesley M Hutto, MS, USA Paul B Schroeder, MSC, USAF Jeffery C Leggit, MC, USA (Ret.)
Military Medicine: 12 September 2018

Chronic exertional compartment syndrome (CECS) is a debilitating condition that is not uncommon in athletes and military service members. The only curative treatment for this condition, surgical fascial release, was first described in 1956. In the ensuing 62 years, this has remained the standard therapy despite symptom recurrence in 45% of military service members who underwent surgery. In 2013, a case series introduced intracompartmental injections of botulinum toxin A as a non-surgical treatment option for CECS, which proved effective in 15 out of 16 patients. In this case report, we present the case of a U.S. military service member treated with BoNT-A for bilateral lower leg CECS. This patient remains pain free at 11 months after initial treatment. This case, coupled with previously published cases series, demonstrates the potential of this novel treatment as a long-term, non-surgical alternative for CECS in the U.S. military population.
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NewsBot · Jan 27, 2021

A literature review exploring the use of botulinum toxin A injection therapy for chronic exertional compartment syndrome treatment
Ebony Love et al
The Foot and Ankle Online Journal 13 (4): 3

Chronic exertional compartment syndrome (CECS) is a rare condition typically affecting runners. It has been speculated that the cause of CECS is due to a transient ischemia occurring during exercise compromising blood flow and leading to increased intramuscular pressure. The first line of treatment for patients is cessation of the aggravating activity which some individuals are less inclined to follow. If conservative treatment fails, the next option is a fasciotomy with a recurrence risk of 44.7%. A review of current literature on treatment options for CECS illustrates preliminary studies of the use of botulinum toxins A injection therapy. The use of botulinum toxin A as a non-surgical option for CECS has been theorized due to the analgesic properties and muscle hypotonia to improve blood flow. The objective of this review was to search the current literature on the use of botulinum toxin A as a treatment option for patients with CECS. A thorough search of the literature via PubMed concerning botulinum toxin as a treatment option for patients with CECS was completed. Botulinum toxin A injections demonstrate a statistically significant decrease in intramuscular pressure in the anterior and lateral compartments of the leg. A high correlation is noted in patients experiencing no exertional pain extending to fourteen months following the injections with no reported adverse effects. Patients were able to resume and continue pre-injections level of activity without any residual effects. Our goal was to investigate the current literature for non-surgical treatments for CECS. The effectiveness of this potential therapy both short term and long term are not fully understood as of yet, however future large prospective randomized controlled studies are needed.
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NewsBot · Jul 22, 2021

Botulinum Toxin A for Chronic Exertional Compartment Syndrome
A Retrospective Study of 16 Upper- and Lower-Limb Cases
Chardin, Marion MD et al
Clinical Journal of Sport Medicine: July 16, 2021

Objective:
To assess initial and mid-term efficacy of botulinum toxin A (BoNT-A) injections in patients with chronic exertional compartment syndrome (CECS) in the lower and upper limbs.

Design:
Retrospective monocentric study.

Setting:
A University Hospital Department of Physical Medicine and Rehabilitation.

Patients:
Sixteen patients with CECS of the lower and upper limbs treated with BoNT-A injections (first-line treatment) were included.

Interventions, Main Outcome Measures:
We collected data from a follow-up consultation (initial pain reduction [complete, partial, or ineffective] and specific activities triggering CECS) and a subsequent phone questionnaire (mid-term efficacy, pain recurrence, and adverse effects).

Results:
Sixteen patients were included (median age: 25.5 years), and 68.75% reported initial efficacy (4 partial and 7 complete); 8/16 patients were able to resume the activity that triggered CECS. All the patients with initial partial efficacy had pain recurrence (median time of 2.25 months). Among patients with initial complete efficacy, 57.14% had recurrence (median time of 5 months). Minor adverse effects were observed, but with no functional impact.

Conclusion:
In 16 individuals with CECS treated with BoNT-A injections, we observed moderate efficacy without major adverse effects, but an initial improvement was often followed by recurrence, especially among those with partial initial efficacy.
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