June 20, 2024

Chronic Exertional Compartment Syndrome is the condition of muscle and nerve which causes pain, swelling, and muscle damage due to a persistent increase in compartment pressure.

Pathology is the same as discussed in acute compartment syndrome

Chronic Exertional Compartment Syndrome
Chronic Exertional Compartment Syndrome

Symptoms

Among four-compartment of legs, the following features occur after having Chronic Exertional Compartment Syndrome which are

  • Recurrent
  • Associated with exercises and worsening with exercises
  • Not necessary with episodes of trauma
  • Improves after cessation of exercises
  • Begins consistency over a particular time, distance, and exercises

Pain over the affected leg especially cramping in nature

Numbness and tingling sensation over the leg

Bulging can be seen

Weakness, sometimes associated with foot drop

Risk factors

  • Heavy workers
  • Long-distance runners
  • Swimmers
  • Military recruits

The anterior and lateral compartments of the legs are most commonly involved

Pathology and Diagnosis

During strenuous exercises: Muscle fiber swells by 20 times

Increasing perfusion of blood muscles hypertrophy interstitial fluid volume: Increase pressure in the non-expanding compartment

Continuous activity will cause pain and a feeling of fullness/cramps-like sensation in the affected compartment

Transient numbness, tingling, weakness in motor, sensory distribution of nerve within the involved compartment

Rest will relieve symptoms but will take time

Direct examination + circumferential measurement: Normal

In unilateral cases: Muscle atrophy can be found

Once pain is produced by provocation exercises: tenderness and increased tension in the compartment may occur

It will increase intra-compartmental pressure at rest

Resting Pressure measurement: ≥ 15 mmHg

After 1 minute exercises: ≥ 30 mmHg

After 5 minutes: ≥ 20 mmHg (Suggestive of CECS)

Valid for the anterior compartment of the leg but not for the posterior compartment

Increase elevated pressure by MRI used to diagnose it

Bone scan (Thallium T1 201): Localized lesion (Ischemia)

Treatment Options

Non-Operative treatment

In Initial stages can help by non-operative measures

Options are:

  • By reducing the number and duration of strenuous activity
  • Stretching involved compartment
    • By orthosis
    • Adequate fluid hydration
    • NSAIDs
    • Icing post exercises

Surgical Treatment

If symptoms persist:

Sub-cutaneous fasciotomy (Shorter incision in comparison to wide skin incision in Acute compartment syndrome)

See also: Compartment Syndrome, Whitesides techniques

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