Disclosures: Bestin Kuriakose, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 39 year old male with history of Raynaud’s syndrome, bilateral compartment syndrome (2002) s/p fasciotomy in 2011. Patient had initial pain relief after fasciotomy but the pain returned over time which required pain relief with oral pain medications. The pain continued to persist, making it difficult to carry out activities of daily living.

Case Description: Pain in the anterior aspect of lower extremities was described as a crushing/burning pain, 8-9/10 in severity that was constant and made worse with cold and exertion. Foot drop developed with over exertion (Right> Left). Pain improved with hot shower, massage, and acupuncture but only provided minimal relief that was temporary. Patient used Vicodin, Percocet, and Gabapentin for pain relief but developed side effects and was interested in other methods to find relief. Discussed alternative treatment modality with IncobotulinumtoxinA injection (50u total) to the right tibialis anterior muscle, at the proximal and distal portion of the muscle belly.

Setting: Outpatient ClinicAssessment/

Results: Patient had improvement in pain score, with reduction of the pain to 3/10 by post injection day 15. On the third day after the injection, patient noticed increased stiffness and swelling in RLE possibly due to a hypersensitivity reaction. Those symptoms subsided within 48 hours and patient had continued pain relief.

Discussion: The aim of this study was to describe the improvement in pain from chronic exertional compartment syndrome with incobotulinumtoxin A injection. It is a neurotoxin produced from Clostridium botulinum that inhibits acetylcholine release from peripheral cholinergic nerve endings which produces a state of denervation. Prior studies have shown the role of OnabotulinumtoxinA injection as a non-surgical treatment option to help abate pain with positive results in patients with chronic exertional compartment syndrome.

Conclusion: IncobotulinumtoxinA can be considered as an option to treat pain from chronic exertional compartment syndrome with the primary goal to wean patients off opioids.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/improvement-in-lower-extremity-chronic-exertional-compartment-syndrome-pain-with-incobotulinumtoxina-injection-a-case-report/