Chronic exertional compartment syndrome of the leg

Abstract

Chronic exertional compartment syndrome (CECS) is an underdiagnosed cause of chronic exertional leg pain. The syndrome most commonly occurs in young adult recreational runners, elite athletes, and military recruits. CECS is caused by increased intracompartmental pressure within a fascial space; however, the mechanism of why pain occurs is unknown. Symptoms are classically pain in the affected compartment at the same time, distance, or intensity of exercise. CECS is a clinical diagnosis; however, it is confirmed by intracompartmental pressure testing. Fasciotomy is the treatment of choice for athletes who would like to maintain the same level of activity. Athletes who have a release of the anterior and lateral compartments have a high success rate.

Compartment Syndromes of Thigh and Lower Leg

“…8) (Stoller 2006;Bauer 1990). Some authors describe a fifth compartment with the tibialis posterior muscle, which is contained with its own (Davey et al 1984;Barnes 1997;Blackman 2000;Brennan and Kane 2003;Bong et al 2005;Tucker 2010). …”

“…9): anterior, the tibialis anterior muscle, long toe extensors, and the deep peroneal nerve (Bauer 1990;Tucker 2010); lateral, the short and long peroneus muscles; deep posterior, tibialis posterior muscle, digitorum longus, and flexor hallucis longus muscles; and superficial posterior, gastrocnemius and soleus muscles. …”

Diagnosis of chronic exertional compartment syndrome in primary care

“…8 The anterior compartment is most commonly affected. 3 Pes planus and overpronation have been found in those with CECS. 9 GPs should examine the patient both before and after exertion to demonstrate a normal physical examination pre-exercise and a …”

“…3,4 It has a widely varying incidence, which has been reported to be between 10-64%. 5 This is because CECS can present with many different symptoms and can therefore be easily misdiagnosed.…”

“…5 However, static intracompartmental pressures at rest and then immediately after exercise can demonstrate the necessary rise in pressure, 3 which is 0-10 mmHg at rest to >25 mmHg after exercise. 12 This simple test, which is cheap and requires minimal training, can be performed either blind or under ultrasound guidance and can lead to definitive surgical management and thus prevent further morbidity.…”