Adductor canal syndrome
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Adductor canal syndrome (also known as adductor canal compression syndrome) is a rare, non-atherosclerotic cause of arterial occlusion and limb ischaemia 1. There is compression of the superficial femoral artery (SFA) in the adductor canal.
Epidemiology
External compression of the superficial femoral artery in the absence of atherosclerotic risk factors causing adductor canal syndrome is rare and available data is limited to case reports 1. The syndrome is most commonly reported in young males less than 45 years old 2.
Clinical presentation
Presentation can vary depending on the severity of the occlusion. The most severe present with symptoms of acute limb ischaemia 1. Compression of the saphenous nerve without vascular involvement can cause pain over the medial aspect of the knee. Symptoms include 2:
- exercise
induced-induced claudication - paraesthesia
- pain
- oedema (due to femoral vein compression)
- pallor
- poikilothermia
- thrombosis leading to acute limb ischaemia
Pathology
There is chronic external compression of the superficial femoral artery as it courses through the adductor canal 1. This results in injury to the vessel, in situ thrombosis, limb ischaemia, and potential limb loss 3,4. The sources of external compression may arise from either an anomalous musculotendinous band arising from the adductor magnus or hypertrophy of the adductor magnus or vastus medialis muscles 2,3,5.
Treatment and prognosis
Treatment is always surgical and involves resection or release of the external compressive forces 1. Angioplasty or bypass of the diseased superficial femoral artery may be required if the mechanical compression has caused vascular damage. Acute limb ischaemia due to thrombosis from adductor canal syndrome requires immediate revascularisation either via endovascular thrombolysis or thromboembolectomy 1. Diagnosis of adductor canal syndrome should prompt investigation for the same condition on the contralateral side 6.
Differential diagnosis
-<p><strong>Adductor canal syndrome</strong> (also known as <strong>adductor canal compression syndrome</strong>) is a rare, non-atherosclerotic cause of arterial occlusion and limb ischaemia <sup>1</sup>. There is compression of the <a title="Superficial femoral artery" href="/articles/superficial-femoral-artery">superficial femoral artery (SFA)</a> in the <a title="Adductor canal" href="/articles/adductor-canal">adductor canal</a>.</p><h4>Epidemiology</h4><p>External compression of the superficial femoral artery in the absence of atherosclerotic risk factors causing adductor canal syndrome is rare and available data is limited to case reports <sup>1</sup>. The syndrome is most commonly reported in young males less than 45 years old <sup>2</sup>.</p><h4>Clinical presentation</h4><p>Presentation can vary depending on the severity of the occlusion. The most severe present with symptoms of <a title="Acute limb ischaemia" href="/articles/acute-limb-ischaemia">acute limb ischaemia</a> <sup>1</sup>. Compression of the <a title="Saphenous nerve" href="/articles/saphenous-nerve">saphenous nerve</a> without vascular involvement can cause pain over the medial aspect of the knee. Symptoms include <sup>2</sup>:</p><ul>-<li>exercise induced claudication</li>- +<p><strong>Adductor canal syndrome</strong> (also known as <strong>adductor canal compression syndrome</strong>) is a rare, non-atherosclerotic cause of arterial occlusion and limb ischaemia <sup>1</sup>. There is compression of the <a href="/articles/superficial-femoral-artery">superficial femoral artery (SFA)</a> in the <a href="/articles/adductor-canal">adductor canal</a>.</p><h4>Epidemiology</h4><p>External compression of the superficial femoral artery in the absence of atherosclerotic risk factors causing adductor canal syndrome is rare and available data is limited to case reports <sup>1</sup>. The syndrome is most commonly reported in young males less than 45 years old <sup>2</sup>.</p><h4>Clinical presentation</h4><p>Presentation can vary depending on the severity of the occlusion. The most severe present with symptoms of <a href="/articles/acute-limb-ischaemia">acute limb ischaemia</a> <sup>1</sup>. Compression of the <a href="/articles/saphenous-nerve">saphenous nerve</a> without vascular involvement can cause pain over the medial aspect of the knee. Symptoms include <sup>2</sup>:</p><ul>
- +<li>exercise-induced claudication</li>
-<li><a title="poikilothermia" href="/articles/poikilothermia">poikilothermia</a></li>- +<li><a href="/articles/poikilothermia">poikilothermia</a></li>
-</ul><h4>Pathology</h4><p>There is chronic external compression of the superficial femoral artery as it courses through the adductor canal <sup>1</sup>. This results in injury to the vessel, in situ thrombosis, limb ischaemia and potential limb loss <sup>3,4</sup>. The sources of external compression may arise from either an anomalous musculotendinous band arising from the adductor magnus or hypertrophy of the <a href="/articles/adductor-magnus-muscle">adductor magnus</a> or <a href="/articles/vastus-medialis-muscle">vastus medialis</a> muscles <sup>2,</sup><sup>3,5</sup>.</p><h4>Treatment and prognosis</h4><p>Treatment is always surgical and involves resection or release of the external compressive forces <sup>1</sup>. Angioplasty or bypass of the diseased superficial femoral artery may be required if the mechanical compression has caused vascular damage. Acute limb ischaemia due to thrombosis from adductor canal syndrome requires immediate revascularisation either via endovascular thrombolysis or thromboembolectomy <sup>1</sup>. Diagnosis of adductor canal syndrome should prompt investigation for the same condition on the contralateral side <sup>6</sup>.</p><h4>Differential diagnosis</h4><ul><li><a href="/articles/popliteal-artery-entrapment-syndrome">popliteal artery entrapment syndrome</a></li></ul>- +</ul><h4>Pathology</h4><p>There is chronic external compression of the superficial femoral artery as it courses through the adductor canal <sup>1</sup>. This results in injury to the vessel, in situ thrombosis, limb ischaemia, and potential limb loss <sup>3,4</sup>. The sources of external compression may arise from either an anomalous musculotendinous band arising from the adductor magnus or hypertrophy of the <a href="/articles/adductor-magnus-muscle">adductor magnus</a> or <a href="/articles/vastus-medialis-muscle">vastus medialis</a> muscles <sup>2,</sup><sup>3,5</sup>.</p><h4>Treatment and prognosis</h4><p>Treatment is always surgical and involves resection or release of the external compressive forces <sup>1</sup>. Angioplasty or bypass of the diseased superficial femoral artery may be required if the mechanical compression has caused vascular damage. Acute limb ischaemia due to thrombosis from adductor canal syndrome requires immediate revascularisation either via endovascular thrombolysis or thromboembolectomy <sup>1</sup>. Diagnosis of adductor canal syndrome should prompt investigation for the same condition on the contralateral side <sup>6</sup>.</p><h4>Differential diagnosis</h4><ul><li><a href="/articles/popliteal-artery-entrapment-syndrome">popliteal artery entrapment syndrome</a></li></ul>
References changed:
- 1. Zhou Y, Ryer EJ, Garvin RP, et al. Adductor canal compression syndrome in an 18-year-old female patient leading to acute critical limb ischemia: A case report. (2017) International journal of surgery case reports. 37: 113-118. <a href="https://doi.org/10.1016/j.ijscr.2017.06.030">doi:10.1016/j.ijscr.2017.06.030</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28654852">Pubmed</a> <span class="ref_v4"></span>
- 2. Sapienza P, Tartaglia E, Venturini L, et al. Adductor canal compression syndrome: a forgotten disease. (2014) Annali italiani di chirurgia. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25559676">Pubmed</a> <span class="ref_v4"></span>
- 3. Walensi M, Berg C, Piotrowski M, et al. Adductor Canal Compression Syndrome in a 46-Year-Old Female Patient Leading to Acute External Iliac, Femoral, and Popliteal Artery Thrombosis and Critical Ischemia: A Case Report. (2017) Annals of vascular surgery. 38: 319.e11-319.e15. <a href="https://doi.org/10.1016/j.avsg.2016.05.134">doi:10.1016/j.avsg.2016.05.134</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27554690">Pubmed</a> <span class="ref_v4"></span>
- 4. Ehsan O, Darwish A, Edmundson C, et al. Non-traumatic lower limb vascular complications in endurance athletes. Review of literature. (2004) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 28 (1): 1-8. <a href="https://doi.org/10.1016/j.ejvs.2004.02.002">doi:10.1016/j.ejvs.2004.02.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/15177226">Pubmed</a> <span class="ref_v4"></span>
- 1. Zhou Y, Ryer EJ, Garvin RP, Irvan JL, Elmore JR. Adductor canal compression syndrome in an 18-year-old female patient leading to acute critical limb ischemia: A case report. (2017) International journal of surgery case reports. 37: 113-118. <a href="https://doi.org/10.1016/j.ijscr.2017.06.030">doi:10.1016/j.ijscr.2017.06.030</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28654852">Pubmed</a> <span class="ref_v4"></span>
- 2. Sapienza P, Tartaglia E, Venturini L, Gallo P, di Marzo L. Adductor canal compression syndrome: a forgotten disease. (2014) Annali italiani di chirurgia. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25559676">Pubmed</a> <span class="ref_v4"></span>
- 3. Walensi M, Berg C, Piotrowski M, Brock FE, Hoffmann JN. Adductor Canal Compression Syndrome in a 46-Year-Old Female Patient Leading to Acute External Iliac, Femoral, and Popliteal Artery Thrombosis and Critical Ischemia: A Case Report. (2017) Annals of vascular surgery. 38: 319.e11-319.e15. <a href="https://doi.org/10.1016/j.avsg.2016.05.134">doi:10.1016/j.avsg.2016.05.134</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27554690">Pubmed</a> <span class="ref_v4"></span>
- 4. Ehsan O, Darwish A, Edmundson C, Mills V, Al-Khaffaf H. Non-traumatic lower limb vascular complications in endurance athletes. Review of literature. (2004) European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 28 (1): 1-8. <a href="https://doi.org/10.1016/j.ejvs.2004.02.002">doi:10.1016/j.ejvs.2004.02.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/15177226">Pubmed</a> <span class="ref_v4"></span>
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