Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome

Williams, Eric H; Detmer, Don E; Guyton, Gregory P; Dellon, A Lee

doi:10.1186/1749-7221-4-4

Journal of Brachial Plexus and Peripheral Nerve Injury

Table 1 Neurosensory Measurements Before & After Stress Testing

From: Non-invasive neurosensory testing used to diagnose and confirm successful surgical management of lower extremity deep distal posterior compartment syndrome

Cutaneous Pressure Thresholds for Static Two-Point Discrimination*
	Prior to 1^st Posterior Distal Compartment Release (A)		After 1^st Posterior Distal Compartment Release (B)		After 2^nd Posterior Distal Compartment Release (C)
RIGHT LEG
Tibial Nerve	Before Exercise	After Exercise	Before Exercise	After Exercise	Before Exercise	After Exercise
Hallux Pulp
mm	10	15	8	12	5	5
gm/mm ²	43	60	46	52	63	66
Medial Heel
mm	11	15	8	12	8	5
gm/mm ²	40	58	82	79	96	68
Peroneal Nerve
1^st web space
mm	5	5	8	10	5	5
gm/mm ²	60	88	60	68	53	56
Dorsolateral**	NA	NA	NA	NA	NA	NA
LEFT LEG
Tibial Nerve
Hallux Pulp
mm	4	8	10	10	5	5
gm/mm ²	38	97	40	52	79	75
Medial Heel
mm	5	15	8	8	5	5
gm/mm ²	45	82	92	69	52	64
Peroneal Nerve
1^st web space
mm	5	5	8	8	5	5
gm/mm ²	35	77	95	80	73	52
Dorsolateral
mm	7	7	7	7	7	7
gm/mm ²	37	78	90	79	53	71

*Two-point static-touch; normative values in the foot for someone less than 45 years of age have a pressure of about 15 gm/mm² to discriminate one from two static points at 6 mm distance apart. ** The right superficial peroneal nerve was resected previously and the anterior and lateral compartments released previously.
A) Interpretation: the distance required to discriminate one from two point static-touchincreased for the tibial nerve on both the right and left sides after exercise, consistent with bilateral (right worse than left) posterior compartment syndrome. Note that the peroneal nerve measurements on the left and right did not change, and that the anterior and lateral compartments had been released previously.
B) Interpretation: There is still an increase in the right tibial nerve measurements for discrimination of one from two point static-touch, indicating that despite fasciotomy of the deep compartment on the right, there is still compression of the tibial nerve in the distal deep compartment. Neurosensory testing demonstrates that another fasciotomy is still required. The lack of change in left tibial nerve may be a timing phenomenon as the right leg was tested first after the patient stopped running.
C) Interpretation: After complete decompression of the deep distal posterior compartment bilaterally, there is now no increase in the distance required to discriminate one from two static-touch points, consistent with complete release of the deep distal posterior compartments and return of normal tibial nerve function.

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