The Pressure Is Rising: Evaluation and Treatment of Chronic Exertional Compartment Syndrome.

ABSTRACT: Chronic exertional compartment syndrome is a condition that typically affects athletic/active individuals. Chronic exertional compartment syndrome predominantly affects the lower leg; however, there are cases involving the hand, forearm, foot, and thigh. The signs and symptoms of chronic exertional compartment syndrome are severe pain, tightness, cramping, muscle weakness, and paresthesias during participation in exercise. Dynamic intramuscular compartmental pressure (preexertion and postexertion) is the standard diagnostic test. Although other imaging modalities, such as radiography, ultrasound, and magnetic resonance imaging are typically incorporated to rule out other pathologies. In addition, these modalities are being utilized to limit invasiveness of the diagnostic experience. Initial care commonly involves conservative treatment, such as physical therapy, modifications of patient's exercise technique, foot orthoses, and various procedures over a period of 3 to 6 months. Recalcitrant cases may be referred for surgical intervention (fasciotomy), which has inconclusive head-to-head data with conservative management with regard to return to prior sport and specific activity level.

Reaching underserved domestic and international populations through Physical Medicine & Rehabilitation Residency training: A survey of residents and program directors.

INTRODUCTION: In 2015, the World Health Organization (WHO) reported that over 400 million individuals worldwide lack access to medical care. In addition, clinicians are more likely to treat underserved patients during their careers if they have exposure to these populations during their training. OBJECTIVES: To analyze what forms of didactic experiences are available and which opportunities are the most valuable with domestic/international underserved populations in Physical Medicine & Rehabilitation (PM&R) residency programs in the United States. DESIGN: Cross-sectional survey using REDCap software. SETTING: PM&R residency programs in the United States. PARTICIPANTS: A total of 137 participants in Accreditation Council of Graduate Medical Education (ACGME)-accredited PM&R residencies in the United States (24 program directors and 113 residents). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Surveys collected information regarding demographic data, prior global health training experiences, current residency training experiences involving domestic/international underserved populations being offered, participants' perceived importance of training experiences with domestic/international underserved population, barriers that impede these experiences, and if availability of these opportunities affected resident recruitment. RESULTS: Participants reported that their PM&R programs did not offer global health simulations (91.2%), educational tracks (75.2%), international electives (71.5%), or rotations with domestic underserved populations (48.9%). Residents viewed exposure to simulation labs (3.25/5), educational tracks (3.42/5), and electives (4.02/5) more importantly than attending physicians. Conversely, attending physicians viewed lectures (3.92/5), journal clubs (3.58), and rotations treating domestic underserved populations (4.42/5) more favorably. Both residents and attending physicians endorse lack of financial support and mentorship as barriers to these opportunities. Participants from all regions outside the Midwest reported that these educational opportunities would affect residency recruitment (56% vs. 31%). CONCLUSIONS: This is the first study assessing the current state of global health training opportunities for PM&R residents as well as the perceived value of such experiences. Many PM&R medical trainees desire exposure to global health medicine curriculum, and many would alter their residency selection based on its availability.