Chronic Exertional Compartment Syndrome in a High School Soccer Player

Abstract

Chronic exertional compartment syndrome (CECS) is a relatively rare condition that affects young adult athletes and often causes them to present to the emergency department. If left untreated, those who continue to compete at high levels may experience debilitating leg pain. Physicians may have difficulty differentiating CECS from other syndromes of the lower leg such as medial tibial stress syndrome, stress fractures, and popliteal artery entrapment. The gold standard for diagnosing CECS is intramuscular compartment pressure monitoring before and/or after 10 minutes of exercise. Some patients may choose to stop participation in sports in order to relieve their pain, which otherwise does not respond well to nonoperative treatments. In patients who wish to continue to participate in sports and live an active life, fasciotomy provides relief in 80% or more. The typical athlete can return to training in about 8 weeks. This is a case of a high school soccer player who stopped competing due to chronic exertional compartment syndrome. She had a fascial hernia, resting intramuscular pressure of 30 mmHg, and postexercise intramuscular pressure of 99 mmHg. Following fasciotomy she experienced considerable life improvement and is once again training and playing soccer without symptoms.

Chronic Compartment Syndrome of Lower Leg. An Unusual Case in Non Athletic Patient

“…One of the most utilised is that developed by Mubarak [16]: a fasciotomy of the anterior and lateral compartments via a 10cm incision. While newer techniques are mini-invasive either via an endoscopic or cutaneous mini-accesses [9][10][11][12][13][14][15][16][17]. These more modern approaches produce results similar to those of interventions using more ample accesses [18].…”

Primary care approach to calf cramps

“…Other modalities to be considered include stretching and strengthening of the lower extremity musculature, massage of the hypertonic musculature compartment, icing and the use of anti-inflammatory medications. [ 22 23 ]…”

Exertional Compartment Syndrome in Five Collegiate Athletes

“…Flick and Flick [5] explain that diagnosis of ECS proves to be difficult as there are no clinically established criteria for diagnosis. Differential diagnoses such as Medial Tibial Stress Syndrome (MTSS), peroneal nerve entrapment, periostitis, anterior tibialis contusions, and stress fractures of tibia need to be ruled out [5,6]. Therefore, delays in early diagnosis and treatments can be detrimental to the athlete as symptoms increase and the possibility of irreversible nerve/ tissue impairment is present.…”

“…Therefore, delays in early diagnosis and treatments can be detrimental to the athlete as symptoms increase and the possibility of irreversible nerve/ tissue impairment is present. Moreover, it has been found that there can be a 22-month delay in diagnosis due to athletes' self-limiting or modifying activity based on pain, which can hinder the diagnostic process [4,6].…”