Current Diagnosis and Management of Chronic Exertional Compartment Syndrome
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Purpose of Review
The goal of this paper is to review the current evidence on diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg. We sought to answer the question of whether recent research and innovations have demonstrated diagnostic alternatives or adjuncts to intramuscular compartment pressure testing and whether there are effective treatment options other than surgical fasciotomy.
Research has shown promising outcomes with non-operative management including targeted alterations to running biomechanics. There is also research demonstrating efficacy in the use of botulinum injection as well as ultrasound-guided fascial fenestration and fasciotomy.
Innovations in the diagnosis of CECS include the use of continuous compartment pressure monitoring during exercise as well as some early research on the use of musculoskeletal ultrasound and particular MRI protocols of the lower leg. Non-surgical management includes intervention to improve running biomechanics, botulinum toxin injection, and ultrasound-guided fasciotomy. Future research is needed on alternative diagnostic modalities including musculoskeletal ultrasound and exercise MRI protocols and on alternative management strategies including botulinum toxin injection and ultrasound-guided fascial fenestration or fasciotomy.
KeywordsChronic exertional compartment syndrome CECS Fasciotomy Gait retraining Running medicine
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently have been highlighted as: • Of importance
- 1.Mavor GE. The anterior tibial syndrome. J Bone Joint Surg Br. 1956;38:513-7.Google Scholar
- 7.Van der Wal WA1, Heesterbeek PJ, Van den Brand JG, Verleisdonk EJ. The natural course of chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2136-41.Google Scholar
- 10.• Roberts A, Roscoe D, Hulse D, Bennett AN, Dixon S. Biomechanical differences between cases with suspected chronic exertional compartment syndrome and asymptomatic controls during running. Gait Posture. 2017;58:374–9. Provided an analysis of biomechanical differences associated with CECS CrossRefPubMedGoogle Scholar
- 11.Breen DT, Foster J, Falvey E, Franklyn-Miller A. Gait re-training to alleviate the symptoms of anterior exertional lower leg pain: a case series. Int J Sports Phys Ther. 2015;10(1):85-94.Google Scholar
- 19.Winkes MB, Tseng CM, Pasmans HL, Cruijsen-Raaijmakers MVD, Hoogeveen AR, Scheltinga MR. Accuracy of palpation-guided catheter placement for muscle pressure measurements in suspected deep posterior chronic exertional compartment syndrome of the lower leg. Am J Sports Med. 2016;44:2659–66.CrossRefPubMedGoogle Scholar
- 28.• Helmhout PH, Diebal AR, Kaaden LVD, Harts CC, Beutler A, Zimmermann WO. The effectiveness of a 6-week intervention program aimed at modifying running style in patients with chronic exertional compartment syndrome. Orthop J Sports Med. 2015; https://doi.org/10.1177/2325967115575691. (Very important) This study prospectively looked at 19 patients with CECS and utilized a 6-week intervention to change to a forefoot strike pattern. They found improvements in running distance and in ICPs. This study highlights that CECS can be successfully treated non-operatively by modifying running mechanics
- 32.• Baria MR, Sellon JL. Botulinum toxin for chronic exertional compartment syndrome. Clin J Sport Med. 2016; https://doi.org/10.1097/jsm.0000000000000289. This case report demonstrates a durable effect of botulinum toxin injection in improving symptoms of CECS
- 33.• Finnoff JT, Rajasekaran S. Ultrasound-guided, percutaneous needle fascial fenestration for the treatment of chronic exertional compartment syndrome: a case report. Pm&r. 2016;8:286–90. (Very important) This was the first report to our knowledge of an ultrasound-guided procedure targeting the muscle fascia for the management of CECS CrossRefGoogle Scholar
- 34.• Balius R, Bong DA, Ardèvol J, Pedret C, Codina D, Dalmau A. Ultrasound-guided fasciotomy for anterior chronic exertional compartment syndrome of the leg. J Ultrasound Med. 2016;35:823–9. Very important) This is the first study describing ultrasound-guided fasciotomy and showed excellent results CrossRefGoogle Scholar