Popliteal entrapment syndrome G047

Current RMA Instruments:

Changes from previous Instruments:

ICD Coding:

• ICD-10-AM Codes: I77.89

Brief description

Popliteal entrapment syndrome is a condition involving occlusion (either partial or complete) of the popliteal artery within the popliteal fossa during plantar flexion. The condition may result from atypical anatomy or compression of the popliteal artery by adjacent musculotendinous structures.

Symptoms may include intermittent lower limb claudication, exercise-induced calf or lower-leg pain, tightness, paraesthesia, or lower limb ischaemia (in the absence of other identifiable vascular risk factors sufficient to account for the symptoms).

Popliteal artery entrapment may be associated with compression of the popliteal vein or tibial nerve. However, the SOP does not cover compression of the popliteal vein or tibial nerve when they occur in isolation. 

Complications may include intimal damage, thrombosis, distal embolisation, post-stenotic dilatation or aneurysm formation.

Confirming the diagnosis

The diagnosis is made clinically, together with appropriate imaging studies demonstrating partial or complete occlusion of the popliteal artery during plantar flexion. Appropriate imaging studies may include:

• Doppler ultrasonography
• MRI or MRA
• CT angiography
• Catheter-based angiography with provocation
• Intravascular ultrasound.

Clinical assessment may include evaluation of exercise-induced lower limb symptoms, vascular insufficiency and provocative examination findings. Diagnostic imaging may assist in distinguishing popliteal entrapment syndrome from other causes of exertional lower limb pain, including chronic exertional compartment syndrome. Management and confirmation are usually undertaken by a vascular surgeon, orthopaedic surgeon or sports physician.

Additional diagnoses covered by SOP

• Popliteal artery entrapment syndrome

Conditions not covered by SOP

• Shin splints * - Medial Tibial Stress Syndrome (Shin splints) SOP
• Chronic exertional compartment syndrome of the lower leg *
• Atherosclerotic peripheral vascular disease * - Peripheral Artery Disease SOP

* another SOP applies - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

Clinical onset generally corresponds to the earliest time at which symptoms and signs consistent with popliteal entrapment syndrome were persistently present. Symptoms commonly occur during exercise and may include intermittent claudication, calf pain, paraesthesia or manifestations of lower limb ischaemia. Imaging confirmation may occur after the date of clinical onset.

Clinical worsening

Clinical worsening may be indicated by increasing frequency or severity of lower limb pain, paraesthesia, stiffness, vascular compromise or functional impairment. Clinical worsening may also be evidenced by progression to arterial damage, thrombosis, post-stenotic dilatation or aneurysm formation. Surgical intervention may be required in some cases. Specialist advice should be sought when assessing for possible clinical worsening and progression beyond the normal clinical course. Adverse outcomes may occur where there is inability to obtain timely and appropriate clinical management.