Chronic Exertional Compartment Syndrome

A Review of the Literature

Trevor T. Bouck, MD; Sreeram Ravi, BA, BS, MS; Phillip J. Stokey, MD; Ethan R. Sawyer, MD; Nabil A. Ebraheim, MD

Disclosures

Curr Orthop Pract. 2022;33(4):320-323. 

In This Article

Abstract and Introduction

Abstract

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower-extremity pain in running athletes. CECS is a transient increase in compartment pressure that can lead to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartment pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity. The aim of this review was to familiarize providers with CECS to increase proper diagnosis and treatment with elective fasciotomy. Proper diagnosis and treatment allow patients to return to their previous level of activity without pain.

Introduction

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower-extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. This exercise-induced condition is believed to be caused by muscle swelling during activity with hypoperfusion of the muscles and the nerve within the involved compartment. CECS is typically relieved rapidly by rest.[1,2] Because of the nonspecific presentation of pain, CECS is commonly overlooked as a cause even though studies show that nearly 27% of cases of anterior leg pain are caused by CECS.[3–5]

CECS was first widely documented in 1912 by Edward Wilson,[3] an Antarctic explorer who documented his symptoms of leg pain during an expedition. Fifty years later, French and Price[6] correlated elevated compartment pressure as a causative factor in CECS of the lower leg.[7,8]

Due to the difficulty in diagnosis as well as a studied delay in seeking treatment for CECS, incidence in the general population is unknown. Thus far, retrospective observational studies of patients referred for compartment pressure measurements report an incidence of confirmed CECS to be 20% to 82%.[9] In a case series of patients with unknown lower-leg pain, Qvarfordt, et al.[10] report the incidence of CECS to be 14%. While overall incidence is unclear, it has been shown that 95% of successfully diagnosed cases occur in the anterior and lateral compartments of the leg. CECS in superficial and deep posterior compartments of the leg and compartments of the thigh and forearm have also been identified, but are significantly more rare.[11,12] CECS typically affects younger patients with a median age of 20 yr old, with no difference between genders.[13]

Members of the military and athletes who participate in repetitive high-impact activity such as running are at greater risk of acquiring CECS. Also at higher risk are people who take supplements that increase muscle volume relative to fascial compartment size, such as anabolic steroids and creatine.[14–18]

The authors' aim was to familiarize the reader with CECS to serve ultimately as an aid for patient providers in considering CECS. This study includes a brief review of pertinent anatomy, common patient presentation, diagnosis confirmation, and treatment options.

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