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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute compartment syndrome of the thigh has been reported infrequently. To date, only eight cases from isolated blunt trauma without fracture have been reported. Two additional cases caused by intramuscular hematomas following blunt, low-energy trauma, which were treated successfully with emergency fasciotomies, are presented. The morbidity from this syndrome varies from mild, with quadriceps weakness, fatigue, and myositis ossificans, to severe, with limb-threatening vascular compromise. Morbidity can be avoided if a high level of suspicion is maintained, compartment pressures are measured, fasciotomies are performed, and hematomas are drained. Postoperatively, patients can expect a dramatic decrease in pain and a quick return of quadriceps function with aggressive physical rehabilitation.
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PMID:Acute anterior thigh compartment syndrome complicating quadriceps hematoma. Two case reports and review of the literature. 218 98

The microcapillary infusion method was evaluated in recording intramuscular pressure during isometric and concentric exercise of the erector spinae muscle. Intramuscular pressure at rest was 6.1 (SD = 1.4) mm Hg without infusion and 8.3 with an infusion rate of 1.5 ml/hour. When the subject experienced muscle fatigue during exercise, the muscle relaxation pressure had increased to 14 mm Hg. The erector spinae muscle was found to be heavily loaded during exercise with an average muscle contraction pressure of 175 mm Hg. Recording of intramuscular pressure in the erector spinae muscle during exercise tests can be an additional method in the study of ergonomics and biomechanics of the spine as well as in the diagnosis of chronic compartment syndrome in this muscle.
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PMID:Pressure in the erector spinae muscle during exercise. 368 19

For evaluation of long-term myoneural function in a compartment syndrome model of the canine hindlimb, five conditioned dogs had injections of autologous plasma into the hindlimb anterolateral muscle compartment, maintaining the pressure at 40 mmHg for eight hours. A newly described technique for measuring muscle function was used before pressurization and at weekly intervals following pressurization for a period of one month. Two days after pressurization, isometric twitch torque and tetanic torque showed a significant decrease (p less than .05) when compared with baseline values. Time to peak tension, one-half relaxation time, and endurance tests showed no significant change throughout the four-week testing. At four weeks following pressurization, no muscle dysfunction was noted, and muscle examined histologically was normal. Therefore, the initial muscle dysfunction present was reversed by skeletal muscle recovery or regeneration. Although no long-term muscle dysfunction occurred in this study of dogs, there may exist a lower tolerance to elevated intramuscular pressure in humans. Since dogs have only fatigue-resistant muscle fibers with higher oxidative capacity than human fibers, dog muscle may have a greater regenerative capacity than human muscle. Therefore, exact extrapolation of these dog studies to clinical compartment syndromes is difficult. Although muscle function was recovered in these animal experiments, human muscle may have less capacity to recover. It is advisable to decompress muscle compartments at a pressure of 30 mmHg as soon as clinical symptoms of a compartment syndrome appear.
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PMID:Long-term myoneural function after an induced compartment syndrome in the canine hindlimb. 397 62

The effect of fasciotomy on muscle tension (measured by a force transducer attached to the tendon) and interstitial fluid pressure (measured by Wick catheters in the muscle belly) was studied in the anterolateral compartments of 13 dog hindlimbs. Muscle tension and pressure were monitored in the tibialis cranialis muscle after low- and high-frequency stimulation of the peroneal nerve to produce twitch- and tetanic-type contractions. Fasciotomy decreased muscle force during the low-frequency stimulation by 16% (35.3 +/- 4.9 to 28.4 +/- 3.9 N) and during the high-frequency stimulation by 10% (60.8 %/- 4.9 to 54.8 +/- 3.9 N). Muscle pressure decreased 50% after fasciotomy under both conditions, 15 +/- 2 to 6 +/- 1 mmHg and 84 +/- 17 to 41 +/- 8 mmHg), respectively. Repeated functional evaluations during the testing procedure indicated that muscle fatigue was not a major factor in these results. It was concluded that fascia is important in the development of muscle tension and changes in interstitial pressure. Furthermore, the results raised questions concerning the merits of performing a fasciotomy for athletes with a compartment syndrome.
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PMID:Role of fascia in maintenance of muscle tension and pressure. 726 38

Our report describes the case of a 20 year old man who developed an acute exertional anterior tibial compartment syndrome after playing soccer for five minutes. No trauma was reported. Correct diagnosis was delayed for 18 hours, because pain was misinterpreted as resulting from acute muscular tetanic spasm induced by hyperventilation. Fasciotomy was contributed. After one year, the patient complained of early fatigue. Electromyographically the reinnervation had not yet been completed. This case illustrates the necessity for careful observation of non-trauma related acute tibial anterior pain appearing even at the beginning of strenuous exercise. It is important to recognize the possibility of a very acute onset of exertional compartment syndrome that does not subside with rest. Only early diagnosis and fasciotomy can prevent severe complications of an acute exertional compartment syndrome.
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PMID:Unusual development of acute exertional compartment syndrome due to delayed diagnosis. A case report. 888 22

Many athletes complain of exercise-induced pain in the lower leg that can be caused by inflammatory diseases, peripheral nervous system disease, fatigue fracture, shin splint, and chronic compartment syndrome (CCS). CCS is the most typical exercise-induced condition and it often requires surgical decompression of the several compartments. There are already many techniques reported in the literature. Recently, an endoscopic technique for CCS was reported with which excellent results were achieved. We have modified it and developed a new technique for treating CCS of the lower leg. We report a case of CCS of the lower leg treated with 1-portal endoscopic fasciotomy. The technique helps to decrease damage to soft tissue and patients will immediately return to normal activities of daily living.
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PMID:One-portal technique of endoscopic fasciotomy: Chronic compartment syndrome of the lower leg. 1160 Sep 73

There are a number of similarities between chronic exertional compartment syndrome (CECS) and the effects of high force eccentric contractions in healthy controls. We hypothesised that CECS patients would be particularly susceptible to pain, fatigue and swelling after eccentric exercise. Ten CECS patients [aged 30.3 (8.0) years, mean (SD)], 7 males) and 14 healthy controls [aged 32.3 (9.0) years, 7 males] performed 40 maximal eccentric contractions of the anterior tibial muscles at an angular velocity of 90(o) s(-1). Maximal voluntary isometric contractions (MVC), force generated by electrical stimulation at 10 Hz and 50 Hz and muscle thickness (measured by real-time ultrasound scanning) were measured before exercise and for 10 min afterwards. Ratings of pain and tenderness were made before exercise, then 24 h and 48 h later. The two groups were comparable for initial isometric strength and muscle size. MVC force immediately after exercise fell to 90 (2.5)% [mean (SEM)] in patients and 86.5 (2.4)% in controls (P<0.0005 for both groups) and had not recovered after 10 min. Preferential loss of force at the low stimulation frequency occurred in both groups to a similar extent (20%, P<0.0005) and continued to decline over 10 min of recovery. There was no significant change in muscle thickness in either group. Only mild pain and tenderness were reported by the controls. The patients showed great individual variation but their mean pain scores were significantly higher during dorsiflexion and palpation (P<0.05) 24 h after exercise. After 48 h the patients reported more pain during dorsiflexion (P=0.005), plantarflexion (P<0.05) and palpation (P<0.05). These results suggest that some, but not all, CECS patients may be more susceptible to the pain associated with eccentric contractions that is thought to be the cause of damage and inflammation of connective tissue.
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PMID:Effect of eccentric exercise on patients with chronic exertional compartment syndrome. 1256 Sep 56

Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. Infected ulcers below the fifth/fourth metatarsal bone in a numb plantar sole often require head resection because of osteomyelitis.From 1994 to 2007 a total of 24 patients with severe pes equinovarus after compartment and/or postischemic syndrome were treated operatively. Only in 5 cases was a triple, Chopart, or Lisfranc arthrodesis necessary; 19 cases however could be treated only by soft tissue procedures like tenolysis, tendon lengthening, medial release of the scarred flexor retinacula and contracted capsules of the posterior ankle, subtalar and talonavicular joint to reorientate all axes of the foot. By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable.The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.
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PMID:[Surgical management of talipes equinovarus as sequelae of a compartment and/or postischemic syndrome of the deep flexor compartment of the lower leg]. 1894 46

Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and subsequent release of intracellular contents. There are many etiologies of rhabdomyolysis, classified here as congenital and acquired; compartment syndrome secondary to trauma with reperfusion injury is one common precipitating factor. Regardless of the underlying etiology, the pathophysiology follows a similar pathway via myocyte destruction and release of myoglobin into the systemic circulation. Rhabdomyolysis-induced renal failure is caused by the precipitation of myoglobin in the renal tubules which is enhanced under acidic conditions. A high index of clinical suspicion is required to promptly recognize rhabdomyolysis, especially in the unconscious patient. Presenting symptoms include tea-colored urine and muscle weakness or fatigue. The diagnosis is confirmed most reliably with the finding of elevated serum creatine kinase levels. Early, aggressive resuscitation with either normal saline or lactated Ringer's solution to maintain an adequate urine output is the most important intervention in preventing the development of acute renal failure. There is insufficient clinical evidence supporting the routine administration of diuretics and bicarbonate to protect against the development of acute renal failure.
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PMID:Rhabdomyolysis in the intensive care unit. 2143 68

Often considered no more than an historical curiosity, writer's cramp remains an important disability in the workplace and the mechanism, which has puzzled the best medical minds for generations, remains contentious. A remarkable range of hypotheses has been put forward to try and explain a disability which periodically reached epidemic and economically worrying levels, but in the end medical opinion has accepted the explanation put forward by neurologists Sheehy and Marsden in 1983 that this was caused by a form of focal dystonia. However, the majority of the historical descriptions of writer's cramp do not fit the classical parameters of focal dystonia and are more accurately described as a progressive forearm muscle fatigue. Today's keyboard operators continue to complain of symptoms identical to their clerical forebears demonstrating that this is a problem which has evolved but not disappeared; this has the paradoxical advantage that modern research techniques enable this complaint to be revisited. The result shows that two varieties of writer's cramp have always existed and while focal dystonia remains a valid explanation for a minority of cases, the much more common fatigue-based complaint is better explained by chronic compartment syndrome of the forearm.
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PMID:Writer's cramp: is focal dystonia the best explanation? 2388 97


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