Disclosures: William A. Berrigan, MD: Nothing to disclose

Case Description: A female runner experienced sharp pain bilaterally in the anterior shin while running. Her symptoms were exacerbated running uphill and relieved after rest. Over time she developed paresthesias in the antero-lateral leg and dorsum of the foot. She attempted stretching and shoe modifications without improvement and was referred to orthopedics. Anterior CECS was suspected and diagnosed via pressure testing. Fasciotomy was recommended, but she elected for non-operative management. Her symptoms continued to worsen to include increased pain and numbness with ambulation. Therefore, she stopped running 3 months prior to presentation and was referred for botulinum toxin injections. Physical exam revealed hyperesthesia in the antero-lateral aspect of the shins bilaterally. EMG was normal. Muscle elastography of the tibialis anterior (TA), extensor digitorum longus (EDL), extensor hallux longus (EHL), and the fibularis brevis (FB) was performed pre-and post-treadmill run. Of note during treadmill testing she reported it took longer for symptoms to begin and they were less severe than prior to her layoff from running.

Setting: Clinical Research Center

Patient: 39-year-old female with chronic exertional compartment syndrome (CECS).

Assessment/Results: An increase in speed and stiffness was noted in the TA, EDL, and EHL on the right and in the TA and FB on the left. However, variability was seen with plantar flexion and dorsiflexion. Full results and numbers to be provided in a table.

Discussion: This case report describes the first reported application of strain elastography to evaluate CECS pre/post botulinum toxin injections. It aids in determining if elastography measures (speed, stiffness) are increased and whether these measures change after botulinum toxin injections.

Conclusion: Previous in vitro studies show there is a correlation between compartmental strain displacements in elastography and intra-compartmental pressure change. More studies are needed to see if elastography can be a reliable non-invasive means for diagnosis of CECPS and whether changes occur following toxin injections.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/botulinum-toxin-a-for-chronic-exertional-compartment-syndrome-evaluated-with-2d-ultrasound-and-shear-wave-elastography-a-case-report/