What is Popliteal Entrapment Syndrome: Causes, Symptoms, Treatment, Classification, Diagnosis

Considered as a serious problem occurring in the legs of a sports person, popliteal entrapment syndrome is a rare vascular disease. Being a part of the pathology, it tends to lead to chronic leg ischemia. Everyone is aware that legs are an important part of the body and such type of problematic issue can put adverse effect on the lower part of leg. Generally, popliteal entrapment syndrome occurs in young athletes that require immediate medical attention; else, the problem may aggravate to permanently damage the artery.

It was in 1879 that popliteal entrapment syndrome was well-explained by a medical student named Anderson Stuart. Further to this, the year of 1959 witnessed first description of the management of popliteal artery syndrome in a 12 year old student. Later on its classification was described by Whelan and Love. In fact, Rignault el. al. explained its functional type in 1985, which was characterized by Levien as that of Type IV popliteal vessels entrapment syndrome.

Popliteal Entrapment Syndrome is a rare disease that occurs between muscle and tendons present near the knee. Ideally stating, it is an uncommon disease taking place in athletes having to do a lot with running and knee exercises. As known to all, the muscles and tendons present close to knee compresses popliteal artery, which is said to be the main artery running between knees. Excess of compression may restrict ample blood flow to the lower part of the leg and lead to grave injury in the artery.

Indeed, some of the patients might be born with the progressive defect of calf muscle. While, other patients might come across this problem as a part of hard fitness regimes leading to enlarged calf muscle putting pressure on the popliteal artery. Basically, popliteal entrapment syndrome is quite often seen in male athletes falling under the age of 30 years, involved in football or rugby. Though, congenital popliteal entrapment syndrome is also seen but rarely.

Since its discovery by Anderson Stuart in the year 1879, Popliteal Entrapment Syndrome was well classified by Love and Whelan into four types:

• Type 1 Popliteal Entrapment Syndrome: The first type calls for an aberrant medical condition due to an abnormal relationship of the popliteal artery with the medial head of gastrocnemius (MHG).
• Type 2 Popliteal Entrapment Syndrome: Though, there is no displacement of the artery, the medial head of gastrocnemius inserts more towards the side compared to the normal and the artery goes below muscle.
• Type 3 Popliteal Entrapment Syndrome: In this case, adjunct slip of MHG hangs nearby the artery.
• Type 4 Popliteal Entrapment Syndrome: Here, artery remains abysmal in popliteal fossa ensnared by popliteus or a fibrous band.
• Type 5 Popliteal Entrapment Syndrome: The popliteal artery as well as the vein is entrapped in this type.

Every type of classification has its treatment procedure that aims to cure it well on time. It all depends on the diagnosis of the disease level that the doctor decides aid.

Considerately, people or athletes suffering from a long-drawn history of pain in legs, feeling of numbness, and frequent occurrence of cramps in calf region at the time of exercise are more prone to get popliteal entrapment syndrome. Though, the symptoms of popliteal entrapment syndrome tend to get vanished in about five minutes; but, in certain cases, swelling in the leg may appear that calls for a thorough check up from doctor because person feels difficulty in walking. Generally, the symptoms of popliteal entrapment syndrome are quite similar to that of adventitial cystic disease.

As a symptomatic compression or constriction of the popliteal artery because of anomalous growth of connexion with medial head of gastrocnemius, one can witness anatomic anomalies in the patient up to 3 percent of the complete population having bilateral nature. Generally stating, people having well developed muscles are likely to be symptomatic with probable chances of getting popliteal entrapment syndrome. Moreover, male sports person are more likely to suffer from popliteal entrapment syndrome as compared to woman sportsperson. This is the reason that males are required to take extra care of their fitness regime and consult the physician on coming across severe pain at calf region.

Though, proper causes are not known; still, excessive exercising and pressure on the calf region of the leg may result in the problem of popliteal entrapment syndrome. The athlete should pay attention to the pain in the leg at initial level and get proper medical aid to stay away from popliteal entrapment syndrome.

Talking about Popliteal Entrapment Syndrome, the main risk factor of having this disease is that the person can suffer from permanent popliteal artery damage. This might not allow him to play further and ruin the career too. It is because of such risk factors that slightest of pain in the artery or calf region should not be ignored at all.

In order to diagnose the problem of popliteal entrapment syndrome, a vascular specialist is needed. At the initial level, a physical exam is conducted that requires for checking of the pulse rate in foot as well as popliteal artery. Along with it, certain diagnostic tests are conducted to measure blood flow in leg, foot and knee regions.

Such types of different tests are:

• Duplex Ultrasound: In this, sound waves are used to take the image of artery and measure blood flow.
• Magnetic Resonance Angiography: As a part of this test, magnetic field with pulses of radio wave energy is used for taking the images of muscle tendons as well as blood vessels present inside the body.
• Ankle Brachial Pressures with exercises: It is meant to measure blood pressure in the legs and arm before and after carrying out an exercising regime.
• Computerized Tomographic Angiography: It is a type of a CT scan that mandates for using a specialized liquid called dye to get the clear picture of areas around the knee section as well as checking blood flow in them.

Surgery is said to be the only treatment of popliteal entrapment syndrome, which requires the surgeon to release the entrapped artery thus providing relief. To get the best of treatment, the patient is required to get admitted 24 hours before the actual surgery happens. In the worst cases, the surgeon needs to conduct bypass surgery around the blocked part of the artery to restore the blood flow. It will surely help the patient to get relief from the excessive pain and the patient suffering from popliteal entrapment syndrome would, typically, be able to get back to the practice in about 6 months to one year.

In the field of sports, popliteal entrapment syndrome is much seen in the players falling under the age group of 30. It is the effect of hard-core fitness regimes that they develop pain in the calf region that may result in the blockage of popliteal artery. To get the problem fixed, one is required to consult with a surgeon. The surgeon tends to carry out specialized diagnostic tests and decides the surgical process as per the severity of popliteal entrapment syndrome. In order to get the proper treatment, the patient has to stay in the hospital for two or three days for after care. As the recovery is complete, patients are allowed to do a little bit of stretching as well as flexibility exercises for faster healing of popliteal entrapment syndrome. On adopting the methodical schedule of after care, medication and exercising, players can get back to their practice within a span of one year.