Popliteal entrapment syndrome is referred to when the popliteal artery is jammed in the popliteal fossa. In most cases, hypertrophy of the gastrocnemius muscle is responsible for compression of the artery. The treatment of choice is surgical decompression of the jammed blood vessel.
What is popliteal entrapment syndrome?
The popliteal artery is the medical term for the continuation of the femoral artery or femoral artery. The popliteal artery passes from the hiatus adductorius through the popliteal fossa to reach the inferior portion of the popliteus muscle, where it branches into the terminal branches, anterior tibial artery and posterior tibial artery. Like all arteries, the popliteal artery carries blood from the heart to the body tissues of the periphery, thus, accordingly, it conducts away from the heart. The supply of blood to tissues corresponds in turn to a supply of oxygen, nutrients and messenger substances, on which all tissues of the body are absolutely dependent. Popliteal entrapment syndrome is a combination of various symptoms that can be caused by compression of the popliteal artery. The symptom combination occurs predominantly when the artery is compressed in the tissues of the popliteal fossa. In most cases, the gastrocnemius muscle and its ligamentous components are involved in the compression. The entrapment of the artery can become a complete popliteal artery occlusion.
Causes
Popliteal entrapment syndrome is caused by jamming of the popliteal artery. In most cases, the artery becomes jammed during exercise. Often, the gastrocnemius muscle slips over the artery, causing the compression. In addition to athletes, people with a hypertrophic gastrocnemius muscle are particularly at risk for entrapment. Hypertrophies are enlargements of tissues caused by cell enlargement. Basically, most hypertrophies develop due to functionally increased stress. Accordingly, the gastrocnemius muscle may hyperplasize as a result of regular exercise. However, tissues can also turn out hypertrophic from birth or become larger due to hormonal correlations. Because the popliteal artery runs in the immediate vicinity of the muscle and its ligamentous apparatus, compression can easily occur with muscle enlargement. Both anatomic structures must pass through the popliteal fossa, so they run directly adjacent through an anatomic constriction. Thus, the likelihood of compression within the popliteal fossa is inherent.
Symptoms, complaints, and signs
Popliteal entrapment syndrome is manifested by a complex of different symptoms. Most commonly, affected individuals are young men up to about 35 years of age. The leading symptom of compression is a pathologically altered foot pulse. For example, the affected person’s foot pulse often disappears completely during certain movements and activities. During extension of the knee, no foot pulse can be detected in patients with popliteal entrapment syndrome in most cases. The foot pulse also appears to be absent during dorsiflexion of the affected foot. Due to the compression, circulatory disturbances occur, which may manifest, for example, in a foot that falls asleep easily. The syndrome causes pain only in the rarest cases. However, an altered warm-cold sensation may occur. Bilateral compression of the artery has been reported in many cases. Depending on the severity and duration of compression, arterial walls may be damaged.
Diagnosis and Course of the Disease
Diagnostic procedures such as Doppler or duplex sonography are used to diagnose popliteal entrapment syndrome. During the examination, the physician asks the patient to extend the knee or dorsiflex the foot, thus documenting the drying up of the arterial current pulse at the popliteal artery in patients with the syndrome. In most cases, the diagnosis cannot be made at rest. That is, sonography on the motionless foot does not provide any evidence of popliteal entrapment syndrome. The prognosis for patients with the syndrome is favorable. In isolated cases, the compression resolves on its own. In all other cases, the physician must intervene as soon as possible after diagnosis to rule out sequelae.
Complications
Primarily, entrapment syndrome results in an altered foot pulse.In most cases, the patient can also feel this change. This change is particularly noticeable during exertion or sporting activities. Furthermore, the compression can lead to various disturbances of the blood circulation, so that the feet fall asleep or tingle. Paralysis or other disturbances of sensitivity can also occur in entrapment syndrome and significantly reduce the quality of life of the affected person. Cramps or pain may also occur. In many cases, the affected person also loses the cold-warm sensation and can no longer distinguish between these conditions properly. If entrapment syndrome is not treated, irreversible damage may occur that cannot be treated or restored. Usually, entrapment syndrome can be treated with the help of surgery. There are no complications or other special complaints. However, the affected person is also dependent on therapies after the operation, so that several years may pass before the foot can be loaded in a normal way again. The patient’s life expectancy is usually not reduced by entrapment syndrome.
When should you see a doctor?
Since this condition is a congenital disease in which there is no self-healing, a doctor must be consulted in any case. A visit to the doctor is necessary if the affected person suffers from a decreased foot pulse. This can occur very suddenly and for no apparent reason. There are disturbances of blood circulation and in many cases also very severe pain, so that the patients also suffer from walking difficulties, which considerably limit and reduce the quality of life. Furthermore, the affected arteries can also be completely damaged if no treatment is initiated. Treatment of this syndrome is usually performed by a specialist, although the disease can also be diagnosed by a general practitioner or by an orthopedist. There are no particular complications and the symptoms can usually be alleviated. The life expectancy of the affected person is also not negatively affected by the disease. Since the syndrome generally has a negative effect on the quality of life of the affected person, psychological complaints may also occur, so that in some cases a visit to the psychologist may also be useful.
Treatment and therapy
Popliteal entrapment syndrome is treated causally. The physician resolves the compression of the artery during a surgical procedure. To plan surgery, the surgeon needs a comprehensive overview of the entrapment. He obtains this overview with procedures such as angiography, CT or MRI. During surgery, the physician removes individual portions of the gastrocnemius muscle to free the popliteal artery from the obstruction. Surgical decompression is often performed relatively immediately after diagnosis because the entrapment increases the risk of thrombosis and therefore should be resolved as soon as possible. After surgery, the affected leg should initially be rested. Targeted physiotherapy may be required after surgical decompression to return the leg to normal weight-bearing capacity. In individual cases, the muscle hypertrophies again years after the operation and a second decompression operation must be scheduled. Usually, patients recover quickly after decompression. All symptoms of popliteal entrapment syndrome usually resolve once the artery has been released from its jam.
Prevention
Popliteal entrapment syndrome can be caused by abnormal strains. For this reason, the syndrome can be prevented to the extent that the popliteal muscles are loaded with understanding. With a tendency to hormonal imbalances, it can also be useful for prevention to have one’s hormone status checked regularly and, if necessary, to counteract rising growth hormone concentrations.
Follow-up care
Follow-up care is limited in this case because popliteal entrapment syndrome is a congenital disease. Thus, the focus is mainly on alleviating symptoms through symptomatic follow-up. Since this disease required surgical intervention, the affected leg should be spared and physical exertion avoided in the period thereafter.Furthermore, physiotherapy can also help to improve the load-bearing capacity of the leg and bring it back to a normal state. Here it is important to observe a good mix of stress and rest. Nutrition also plays an important role in aftercare, as excess weight can exacerbate the symptoms. Since the disease can have a negative impact on the patient’s quality of life, especially in athletic people, psychological support is necessary in some cases. After the disease with popliteal entrapment syndrome, a follow-up examination by the general practitioner is advisable to clarify whether there are any hormonal imbalances or problems. In this case, growth hormones may need to be taken in some cases. The prognosis for politeal entrepment syndrome tends to be positive. Complaints can be relieved and life expectancy is not affected by the disease.
What you can do yourself
Popliteal entrapment syndrome is mostly cured by surgery. Afterward, the lower leg regains proper blood flow, with additional therapies serving as support. Following surgery, patients are initially allowed to put only careful weight on the leg and foot. The resting phase is followed by physiotherapy, which makes the knee mobile and restores normal weight-bearing capacity. Here, patients should be careful to maintain the right balance between exercise training, weight-bearing and rest. To prevent the muscle from hypertrophying again, physiotherapeutic measures can be continued on an ongoing basis. In addition to physical exercise, nutrition also plays a certain role, because overweight increases the symptoms. Especially for athletes and active people, the diagnosis is often a psychological burden. That is why it can be useful to find a self-help group. Here, those affected encourage each other and can exchange their individual experiences. At the first symptoms and also at a later stage, incorrect and excessive stress should be avoided at all costs. That is why it is so important that the knee muscles are stressed to a reasonable degree. Regular monitoring of hormone status is not only recommended for adolescents.