Skip to main content

Chronic Exertional Compartment Syndrome

  • 1803 Accesses

Abstract

Chronic exertional compartment syndrome is characterized by pain that is associated with exercise or physical training that commonly necessitates cessation of the inciting activity and can therefore be of significant concern for athletes. Classically a condition of runners, it is caused by an increase in pressure within a fascial compartment that results from muscular function during exercise. Chronic exertional compartment syndrome should be on the differential for any athlete presenting with chronic exercise-induced pain of the leg; proper clinical history, physical exam, and diagnostic work-up will differentiate it from other etiologies of this common presenting complaint. This topic has historically been characterized by some degree of debate with regard to the specific indications and varying methods of both diagnostic management and treatment. As conservative measures have proved largely ineffective, the mainstay of treatment for this condition is surgical release of the fascial compartment involved. There are several techniques for this procedure described in the literature that have proven successful.

Keywords

  • Compartment syndrome
  • Exertional
  • Compartmental monitoring
  • Leg pain
  • Endurance athlete
  • Running
  • Fasciotomy
  • Fasciectomy
  • Shin splints
  • Tibial pain
  • Stress fracture
  • Intermittent claudication

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-319-32982-6_9
  • Chapter length: 13 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   84.99
Price excludes VAT (USA)
  • ISBN: 978-3-319-32982-6
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   109.99
Price excludes VAT (USA)
Hardcover Book
USD   159.99
Price excludes VAT (USA)
Fig. 9.1
Fig. 9.2
Fig. 9.3
Fig. 9.4
Fig. 9.5
Fig. 9.6
Fig. 9.7

References

  1. Mavor G. The anterior tibial syndrome. J Bone Joint Surg. 1956;38:513–7.

    Google Scholar 

  2. Freedman B. Dr. Edward Wilson of the Antarctic; a biographical sketch, followed by an inquiry into the nature of his last illness. Proc R Soc Med. 1954;47(3):183–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. French E, Price W. Anterior tibial pain. Br Med J. 1962;2(5315):1290–6.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  4. van den Brand JG, Verleisdonk EJ, van der Werken C. Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome. Am J Sports Med. 2004;32(2):452–6.

    CrossRef  PubMed  Google Scholar 

  5. Verleisdonk EJ, Schmitz RF, van der Werken C. Long-term results of fasciotomy of the anterior compartment in patients with exercise-induced pain in the lower leg. Int J Sports Med. 2004;25(3):224–9.

    CAS  CrossRef  PubMed  Google Scholar 

  6. Waterman BR, Laughlin M, Kilcoyne K, Cameron KL, Owens BD. Surgical treatment of chronic exertional compartment syndrome of the leg: failure rates and postoperative disability in an active patient population. J Bone Joint Surg Am. 2013;95(7):592–6.

    CrossRef  PubMed  Google Scholar 

  7. Styf J. Diagnosis of exercise-induced pain in the anterior aspect of the lower leg. Am J Sports Med. 1988;16(2):165–9.

    CAS  CrossRef  PubMed  Google Scholar 

  8. Rajasekaran S, Kvinlaug K, Finnoff JT. Exertional leg pain in the athlete. PM & R. 2012;4(12):985–1000.

    CrossRef  Google Scholar 

  9. Winkes M, Hoogeveen A, Scheltinga M. Is surgery effective for deep posterior compartment syndrome of the leg? A systematic review. Br J Sports Med. 2014;48:1592–8.

    CrossRef  PubMed  Google Scholar 

  10. Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. 2000;32 Suppl 3:S4–10.

    CAS  PubMed  Google Scholar 

  11. Davis DE, Raikin S, Garras DN, Vitanzo P, Labrador H, Espandar R. Characteristics of patients with chronic exertional compartment syndrome. Foot Ankle Int. 2013;34(10):1349–54.

    CrossRef  PubMed  Google Scholar 

  12. Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. 1985;13(3):162–70.

    CAS  CrossRef  PubMed  Google Scholar 

  13. Gerow G, Matthews B, Jahn W, Gerow R. Compartment syndrome and shin splints of the lower leg. J Manipulative Physiol Ther. 1993;16(4):245–52.

    CAS  PubMed  Google Scholar 

  14. Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990;18(1):35–40.

    CAS  CrossRef  PubMed  Google Scholar 

  15. Reneman RS. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles. Clin Orthop Relat Res. 1975;113:69–80.

    CrossRef  Google Scholar 

  16. Touliopolous S, Hershman EB. Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Sports Med. 1999;27(3):193–204.

    CAS  CrossRef  PubMed  Google Scholar 

  17. Edwards P, Myerson MS. Exertional compartment syndrome of the leg: steps for expedient return to activity. Phys Sportsmed. 1996;24(4):31–46.

    CAS  CrossRef  PubMed  Google Scholar 

  18. Mouhsine E, Garofalo R, Moretti B, Gremion G, Akiki A. Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):193–7.

    CAS  CrossRef  PubMed  Google Scholar 

  19. Wilder RP, Magrum E. Exertional compartment syndrome. Clin Sports Med. 2010;29(3):429–35.

    CrossRef  PubMed  Google Scholar 

  20. Aweid O, Del Buono A, Malliaras P, Iqbal H, Morrissey D, Maffulli N, et al. Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin J Sport Med. 2012;22(4):356–70.

    CrossRef  PubMed  Google Scholar 

  21. Packer JD, Day MS, Nguyen JT, Hobart SJ, Hannafin JA, Metzl JD. Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. Am J Sports Med. 2013;41(2):430–6.

    CrossRef  PubMed  Google Scholar 

  22. Bong MR, Polatsch DB, Jazrawi LM, Rokito AS. Chronic exertional compartment syndrome: diagnosis and management. Bull Hosp Joint Dis. 2005;62(3–4):77–84.

    Google Scholar 

  23. Amendola A, Rorabeck CH, Vellett D, Vezina W, Rutt B, Nott L. The use of magnetic resonance imaging in exertional compartment syndromes. Am J Sports Med. 1990;18(1):29–34.

    CAS  CrossRef  PubMed  Google Scholar 

  24. Balduini FC, Shenton DW, O’Connor KH, Heppenstall RB. Chronic exertional compartment syndrome: correlation of compartment pressure and muscle ischemia utilizing 31P-NMR spectroscopy. Clin Sports Med. 1993;12(1):151–65.

    CAS  PubMed  Google Scholar 

  25. Trease L, van Every B, Bennell K, Brukner P, Rynderman J, Baldey A, et al. A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg. Eur J Nucl Med. 2001;28(6):688–95.

    CAS  CrossRef  PubMed  Google Scholar 

  26. Dahl M, Hansen P, Stal P, Edmundsson D, Magnusson SP. Stiffness and thickness of fascia do not explain chronic exertional compartment syndrome. Clin Orthop Relat Res. 2011;469(12):3495–500.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  27. Fields KB. Running injuries—changing trends and demographics. Curr Sports Med Rep. 2011;10(5):299–303.

    CrossRef  PubMed  Google Scholar 

  28. Hislop M, Batt ME. Chronic exertional compartment syndrome testing: a minimalist approach. Br J Sports Med. 2011;45(12):954–5.

    CrossRef  PubMed  Google Scholar 

  29. Cook S, Bruce G. Fasciotomy for chronic compartment syndrome in the lower limb. ANZ J Surg. 2002;72(10):720–3.

    CrossRef  PubMed  Google Scholar 

  30. Hutchinson M. Chronic exertional compartment syndrome. Br J Sports Med. 2011;45(12):952–3.

    CrossRef  PubMed  Google Scholar 

  31. Roscoe D, Roberts AJ, Hulse D. Intramuscular compartment pressure measurement in chronic exertional compartment syndrome: new and improved diagnostic criteria. Am J Sports Med. 2015;43(2):392–8.

    CrossRef  PubMed  Google Scholar 

  32. Rajasekaran S, Beavis C, Aly AR, Leswick D. The utility of ultrasound in detecting anterior compartment thickness changes in chronic exertional compartment syndrome: a pilot study. Clin J Sport Med. 2013;23(4):305–11.

    CrossRef  PubMed  Google Scholar 

  33. George CA, Hutchinson MR. Chronic exertional compartment syndrome. Clin Sports Med. 2012;31(2):307–19.

    CrossRef  PubMed  Google Scholar 

  34. Hislop M, Tierney P. Intracompartmental pressure testing: results of an international survey of current clinical practice, highlighting the need for standardised protocols. Br J Sports Med. 2011;45(12):956–8.

    CrossRef  PubMed  Google Scholar 

  35. Roberts A, Franklyn-Miller A. The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports. 2012;22(5):585–95.

    CAS  CrossRef  PubMed  Google Scholar 

  36. Sigmund EE, Sui D, Ukpebor O, Baete S, Fieremans E, Babb JS, et al. Stimulated echo diffusion tensor imaging and SPAIR T2-weighted imaging in chronic exertional compartment syndrome of the lower leg muscles. J Magn Reson Imaging. 2013;38(5):1073–82.

    CrossRef  PubMed  Google Scholar 

  37. Yilmaz TF, Toprak H, Bilsel K, Ozdemir H, Aralasmak A, Alkan A. MRI findings in crural compartment syndrome: a case series. Emerg Radiol. 2014;21(1):93–7.

    CrossRef  PubMed  Google Scholar 

  38. Ringler MD, Litwiller DV, Felmlee JP, Shahid KR, Finnoff JT, Carter RE, et al. MRI accurately detects chronic exertional compartment syndrome: a validation study. Skeletal Radiol. 2013;42(3):385–92.

    CrossRef  PubMed  Google Scholar 

  39. Ali T, Mohammed F, Mencia M, Maharaj D, Hoford R. Surgical management of exertional anterior compartment syndrome of the leg. West Indian Med J. 2013;62(6):529–32.

    CAS  CrossRef  PubMed  Google Scholar 

  40. Paik RS, Pepple DA, Hutchinson MR. Chronic exertional compartment syndrome. BMJ. 2013;346:f33.

    CrossRef  PubMed  Google Scholar 

  41. Edwards Jr PH, Wright ML, Hartman JF. A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med. 2005;33(8):1241–9.

    CrossRef  PubMed  Google Scholar 

  42. Turnipseed WD. Popliteal entrapment in runners. Clin Sports Med. 2012;31(2):321–8.

    CrossRef  PubMed  Google Scholar 

  43. Blackman PG, Simmons LR, Crossley KM. Treatment of chronic exertional anterior compartment syndrome with massage: a pilot study. Clin J Sport Med. 1998;8(1):14–7.

    CAS  CrossRef  PubMed  Google Scholar 

  44. Diebal AR, Gregory R, Alitz C, Gerber JP. Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med. 2012;40(5):1060–7.

    CrossRef  PubMed  Google Scholar 

  45. Franklyn-Miller A, Roberts A, Hulse D, Foster J. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med. 2014;48(6):415–6.

    CrossRef  PubMed  Google Scholar 

  46. Rorabeck CH. A practical approach to compartmental syndrome. Part III. Management. Instr Course Lect. 1983;32:102–13.

    CAS  PubMed  Google Scholar 

  47. Slimmon D, Bennell K, Brukner P, Crossley K, Bell SN. Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg. Am J Sports Med. 2002;30(4):581–8.

    PubMed  Google Scholar 

  48. Lohrer H, Nauck T. Endoscopically assisted release for exertional compartment syndromes of the lower leg. Arch Orthop Trauma Surg. 2007;127(9):827–34.

    CrossRef  PubMed  Google Scholar 

  49. Wittstein J, Moorman 3rd CT, Levin LS. Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results. Am J Sports Med. 2010;38(8):1661–6.

    CrossRef  PubMed  Google Scholar 

  50. Sebik A, Dogan A. A technique for arthroscopic fasciotomy for the chronic exertional tibialis anterior compartment syndrome. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):531–4.

    CrossRef  PubMed  Google Scholar 

  51. van Zoest WJ, Hoogeveen AR, Scheltinga MR, Sala HA, van Mourik JB, Brink PR. Chronic deep posterior compartment syndrome of the leg in athletes: postoperative results of fasciotomy. Int J Sports Med. 2008;29(5):419–23.

    CrossRef  PubMed  Google Scholar 

  52. Edmundsson D, Toolanen G, Sojka P. Chronic compartment syndrome also affects nonathletic subjects: a prospective study of 63 cases with exercise-induced lower leg pain. Acta Orthop. 2007;78(1):136–42.

    CrossRef  PubMed  Google Scholar 

  53. Waterman BR, Liu J, Newcomb R, Schoenfeld AJ, Orr JD, Belmont Jr PJ. Risk factors for chronic exertional compartment syndrome in a physically active military population. Am J Sports Med. 2013;41(11):2545–9.

    CrossRef  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robin West .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

West, R., Ferguson, J., Butler, A. (2016). Chronic Exertional Compartment Syndrome. In: Miller, T. (eds) Endurance Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-32982-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-32982-6_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32980-2

  • Online ISBN: 978-3-319-32982-6

  • eBook Packages: MedicineMedicine (R0)