Der Unfallchirurg
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Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. ⋯ A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.
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Damage to health caused by complications and errors is part of the reality of medical treatment. In order to avoid further negative consequences in the event of legal claims as a result of excessive processing times or unjustified refusals, a good cooperation between the physician and claims management in the clinic and the legal processor in liability insurance is required. In order to avoid false assumptions in claims processing, a critical analysis of the facts of the case is necessary. In addition, findings from claims management must be recorded and effectively implemented in the clinical practice.
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Exercise-induced leg pain (ELP) and tightness may be caused by a chronic exertional compartment syndrome (CECS). Although CECS can develop in any muscle compartment, most individuals suffer from an anterior tibial muscle CECS (ant-CECS). Typically, a patient with ant-CECS experiences discomfort toward the end of sports activity or in the hours thereafter. ⋯ A fasciotomy must be considered in recalcitrant cases. Residual or recurrent disease may necessitate partial removal of the fascia. The aim of this overview is to discuss the management of CECS in the anterolateral portion of the leg.
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Medial tibial stress syndrome is a common overuse injury in jumping and running athletes. It is defined as exercise-induced pain along the distal posteromedial border of the tibia and the presence of recognisable pain on palpation over a length of 5 or more centimetres. This overview article provides an evidence update on the diagnosis and management of athletes with medial tibial stress syndrome.
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A small proportion of patients with exertional leg pain (ELP) have deep posterior chronic exertional compartment syndrome (dp-CECS). These individuals report pain, tightness and cramps deep in the calf muscles that are elicited by exercise, but may also be present during rest to a lesser extent. Physical examination often reveals painful palpation of the flexor muscles in the area immediately dorsomedial to the tibial bone. ⋯ Various entities may mimic or coincide with dp-CECS, including medial tibial stress syndrome (MTSS) and popliteal artery entrapment syndrome (PAES). Fasciotomy of multiple flexor muscles is the only treatment that achieves a beneficial outcome. The aim of this overview is to discuss the diagnosis and management of dp-CECS.