Unilateral Exertional Compartment Syndrome in a Pediatric Competitive Figure Skater.

Alexandra M Patterson Tichy,Chris Bradley

doi:10.7759/cureus.5611

Abstract

Chronic exertional compartment syndrome (CECS) occurs when there is an increase in interstitial pressure within a non-compliant fascial compartment during exercise. The hallmark sign of CECS is a consistent onset of symptoms at a specific time, distance or intensity of activity followed by resolution of symptoms when the activity is stopped. Chronic exertional compartment syndrome commonly occurs in the lower legs, is bilateral 85% to 95% of the time and occurs most often in running athletes. The purpose of this case report is to describe the clinical presentation of unilateral chronic exertional compartment syndrome in a pediatric athlete that did not present with the hallmark signs for CECS and additionally participates in a sport where CECS is not common.The subject is a 13 year old female competitive figure skater who presented to physical therapy with right calf pain when figure skating and performing functional tasks. During the initial evaluation the patient had pain at rest as well as with objective testing of the right lower leg. The patient did not progress as expected in physical therapy and therefore the differential diagnosis was re-visited and additional measures were performed. The patient was re-diagnosed with unilateral chronic exertional compartment syndrome. The diagnosis was first clinical and later confirmed by intracompartmental testing.This case report illustrates a patient diagnosed with CECS by intra-compartmental pressure testing that did not present with the standard signs and symptoms; she did not participate in a sport where CECS is typically seen and her symptoms were unilateral. This report represents the importance of consistently including CECS in the differential diagnosis of lower leg pain in athletes regardless of the initial presentation and the sport in which they participate. Additionally, it highlights the importance of a detailed subjective history and the significance of aggravating and alleviating factors in relation to training.

Highlights

Chronic exertional compartment syndrome (CECS) occurs when there is an elevation of interstitial pressure within a closed fascial compartment which leads to pain and symptoms within the compartments affected [1]
Figure skaters put more stress on their landing leg during jumping which may increase the likelihood of developing CECS in the lower extremity that undergoes a higher intensity of physical stress during training. This differs from the more common bilateral presentation of CECS. The purpose of this case report is to describe the clinical presentation of unilateral chronic exertional compartment syndrome in a pediatric athlete that did not present with the hallmark signs for CECS and participates in a sport where CECS is not common
This case report presents an example of a sport where the hallmark sign for CECS may not be as evident

Summary

Introduction

Chronic exertional compartment syndrome (CECS) occurs when there is an elevation of interstitial pressure within a closed fascial compartment which leads to pain and symptoms within the compartments affected [1]. The diagnosis of CECS is initially clinical and due to difficulty of diagnosis, is often delayed, taking an average of 22 months from the onset of symptoms and initiation of treatment [4,7] This case report describes the physical therapy evaluation and diagnosis of unilateral chronic exertional compartment syndrome in a competitive singles figure skater. Figure skaters put more stress on their landing leg during jumping which may increase the likelihood of developing CECS in the lower extremity that undergoes a higher intensity of physical stress during training This differs from the more common bilateral presentation of CECS. A 13 year old female competitive figure skater presented to the physical therapy clinic with right calf pain that began two months earlier Prior to her injury the patient was competing in the singles discipline of figure skating.

Discussion

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Disclosures