Chronic Exertional Compartment Syndrome of the Leg Management Is Changing: Where Are We and Where Are We Going?

Nwakibu, Uzoma; Schwarzman, Garrett; Zimmermann, W; Hutchinson, Mark R.

doi:10.1249/jsr.0000000000000762

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…A summary of the types of manuscripts included in this review is shown in Table 3. Noncomparative studies including opinion pieces/narrative reviews accounted for 45.4% of the included manuscripts [4, 6, 33–84], case reports (22%) [7, 85–109], and case series studies (17%) [110–129]. Five percent of the included manuscripts were systematic reviews [5, 130–134].…”

Section: Resultsmentioning

confidence: 99%

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review

Bosnina,

Padhiar,

Miller

et al. 2023

Journal of Foot and Ankle Research

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BackgroundNumerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions.MethodsThree online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP. We included manuscripts considering all adults with any reported diagnostic criteria for EILP in any setting. Methodological quality was assessed using the Mixed Method Appraisal tool. Condition definitions were identified and categorised during data charting. Twenty-five potential elements of the history, 24 symptoms, 41 physical signs, 21 investigative tools, and 26 overarching diagnostic criteria, were identified and coded as counts of recommendation per condition, alongside qualitative analysis of the clinical reasoning. Condition definitions were constructed with 11 standardised elements based on recent consensus exercises for other conditions.ResultsOne hundred nineteen retained manuscripts, of which 18 studied multiple conditions, had a median quality of 2/5. A combination of the history, pain location, symptoms, physical findings, and investigative modalities were fundamental to identify each sub-diagnosis alongside excluding differentials. The details differed markedly for each sub-diagnosis. Fifty-nine manuscripts included data on chronic exertional compartment syndrome (CECS) revealing exertional pain (83% history), dull aching pain (76% symptoms), absence of physical signs (78% physical findings) and elevated intercompartment pressure (93% investigative modality). Twenty-one manuscripts included data on medial tibial stress syndrome (MTSS), revealing persistent pain upon discontinuation of activity (81% history), diffuse medial tibial pain (100% pain location), dull ache (86% symptoms), diffuse tenderness (95% physical findings) and MRI for exclusion of differentials (62% investigative modality). Similar analyses were performed for stress fractures (SF,n = 31), popliteal artery entrapment syndrome (PAES,n = 22), superficial peroneal nerve entrapment syndrome (SPNES,n = 15), lumbar radiculopathy (n = 7), accessory/low-lying soleus muscle syndrome (ALLSMS,n = 5), myofascial tears (n = 3), and McArdle’s syndrome (n = 2).ConclusionInitial diagnostic frameworks and definitions have been developed for each condition of the nine most common conditions that cause EILP, suitable for clinical consideration and consensus confirmation.

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Section: Resultsmentioning

confidence: 99%

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review

Bosnina,

Padhiar,

Miller

et al. 2023

Journal of Foot and Ankle Research

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“…Based on military studies, Velasco et al reported an incidence of 1 in 2000 persons per year [4]. In the Nwakibu review, CECS was diagnosed in 0.49 per 1000 of the United States Army [1]. The incidence of CECS in the general population is still unknown to date.…”

Section: Review Prevalencementioning

confidence: 99%

“…The classic symptoms of CECS are pain, muscle tightness and weakness, muscle cramps, and paresthesia. Symptoms are alleviated by prompt exercise cessation and rest [1,2]. The CECS diagnosis is, however, quite challenging due to the nebulosity of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature

Tarabishi,

Almigdad,

Almonaie

et al. 2023

Cureus

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Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels.The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps.Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard.Management includes both conservative and surgical options. Conservative treatment includes gait retraining and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities.This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.

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“…With repetitive exercise, this increased perfusion causes an elevation in intracompartmental pressure (ICP), which cannot be accommodated by the surrounding fascia. This subsequently impairs local tissue perfusion and results in symptoms, including severe pain, tightness, cramping, muscle weakness, and paresthesias (5).…”

Section: Introductionmentioning

confidence: 99%

The Pressure Is Rising: Evaluation and Treatment of Chronic Exertional Compartment Syndrome

Malik

Vyas

2023

Curr Sports Med Rep

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Chronic exertional compartment syndrome is a condition that typically affects athletic/active individuals. Chronic exertional compartment syndrome predominantly affects the lower leg; however, there are cases involving the hand, forearm, foot, and thigh. The signs and symptoms of chronic exertional compartment syndrome are severe pain, tightness, cramping, muscle weakness, and paresthesias during participation in exercise. Dynamic intramuscular compartmental pressure (preexertion and postexertion) is the standard diagnostic test. Although other imaging modalities, such as radiography, ultrasound, and magnetic resonance imaging are typically incorporated to rule out other pathologies. In addition, these modalities are being utilized to limit invasiveness of the diagnostic experience. Initial care commonly involves conservative treatment, such as physical therapy, modifications of patient's exercise technique, foot orthoses, and various procedures over a period of 3 to 6 months. Recalcitrant cases may be referred for surgical intervention (fasciotomy), which has inconclusive head-to-head data with conservative management with regard to return to prior sport and specific activity level.

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Chronic Exertional Compartment Syndrome of the Leg Management Is Changing: Where Are We and Where Are We Going?

Cited by 11 publications

References 31 publications

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review

Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature

The Pressure Is Rising: Evaluation and Treatment of Chronic Exertional Compartment Syndrome

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