Chronic Exertional Compartment Syndrome Research Articles

Chronic Exertional Compartment Syndrome in a Healthy Young Man

ObjectiveThe purpose of this case report is to describe a patient who presented with symptoms of exercise-induced compartment syndrome and was later referred for bilateral fasciotomy surgery. Clinical FeaturesA 21-year-old patient presented for chiropractic care with the inability to run due to foot paresthesia and weakness. An exertion test and compartment pressure test diagnosed exercise-induced compartment syndrome. Exertion test and compartment pressure test were used to identify and diagnose exercise-induced compartment syndrome. Intervention and OutcomeThe patient was diagnosed with exercise-induced compartment syndrome. He was treated conservatively and referred for additional testing. The orthopedic surgeon requested that 12 weeks of conservative care be provided prior to testing; treatment consisted of chiropractic care and rehabilitation exercises. Following the 12 weeks of treatment, the patient did not significantly respond to conservative care. A compartment pressure test confirmed the initial diagnosis of exercise-induced compartment syndrome. The patient underwent a unilateral fasciotomy surgery and recovered fully. Following the surgery, the patient returned to the chiropractic clinic with the same presentation in the contralateral leg. The same protocol of management resulted in the same outcome. Two years after surgical intervention, the patient continues to maintain an active lifestyle, able to run 2 to 3 miles per day without any exacerbations or symptomatology. ConclusionClinical awareness, a detailed history, and thorough examination with reproduction of symptomatology are necessary to form a proper diagnosis and treatment plan for these patients. Therefore, multidisciplinary medical communication would prove to be the most beneficial approach for the patient.

Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg.

BackgroundChronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity.MethodsThe study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded.ResultsThe median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded.ConclusionsMinimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term.

Lower Leg Pain- Basketball

HISTORY: 15yoM no PMH presented with severe 10/10 right lower leg pain that started progressively 6 hours ago while playing basketball. Prior to the game, patient had no symptoms. He denies any trauma to the leg during the game. The pan is localized to the anterior and lateral aspects of the right lower leg with only mild pain noted posteriorly. Patient stated similar pains over the past year during exercise but today pain is much more severe and not improving with rest. Also c/o numbness in his foot and is having difficulty lifting his foot. PHYSICAL EXAM: No obvious deformities or signs of trauma. The anterior lower leg is extremely firm and tender to palpation with painful passive ROM and weakness and pain with active ROM. Decreased sensation of 1st dorsal webspace. Palpable DP pulse. No overlying skin changes or mottling. DDx: 1. Medial tibial stress syndrome 2. Compartment syndrome 3. Tibial stress fracture 4. Acute arterial occlusion 5. Acute venous occlusion TESTS AND RESULTS: xray tib/fib normal compartment pressures: Anterior: 80, Lateral: 62, Post- 20, Deep post- 15 FINAL DIAGNOSIS: Acute on chronic exertional compartment syndrome TREATMENT AND OUTCOMES: Patient went directly to the OR for fasciotomy Outcome pending

Muscle Microvascular Blood Flow, Oxygenation, and pH as Potential Diagnostic Parameters for Chronic Exertional Compartment Syndrome

Muscle Microvascular Blood Flow, Oxygenation, and pH as Potential Diagnostic Parameters for Chronic Exertional Compartment Syndrome

Endoscopic-assisted Release of Lower Leg Chronic Exertional Compartment Syndromes: Results of a Systematic Literature Review.

Endoscopic treatment of recalcitrant chronic exertional compartment syndromes (CECS) of the lower leg is rarely reported. Until now, endoscopic release of CECS of the lower leg is described in only 3 papers addressing 48 interventions in 30 patients. A systematic literature analysis was performed comparing endoscopic and minimally invasive lower leg CECS releases. No statistically relevant difference was found between the results of endoscopic (unweighted mean success rate=86.3%) and minimally invasive (unweighted mean success rate=80.0%) CECS release. However, the methodological quality of the analyzed studies is not sufficient and the number of endoscopically treated patients are too low to draw final conclusions.

Orthopaedic Perspective on Barefoot and Minimalist Running.

In recent years, there has been a movement toward barefoot and minimalist running. Advocates assert that a lack of cushion and support promotes a forefoot or midfoot strike rather than a rearfoot strike, decreasing the impact transient and stress on the hip and knee. Although the change in gait is theorized to decrease injury risk, this concept has not yet been fully elucidated. However, research has shown diminished symptoms of chronic exertional compartment syndrome and anterior knee pain after a transition to minimalist running. Skeptics are concerned that, because of the effects of the natural environment and the lack of a standardized transition program, barefoot running could lead to additional, unforeseen injuries. Studies have shown that, with the transition to minimalist running, there is increased stress on the foot and ankle and risk of repetitive stress injuries. Nonetheless, despite the large gap of evidence-based knowledge on minimalist running, the potential benefits warrant further research and consideration.

Fasciotomy for Deep Posterior Compartment Syndrome in the Lower Leg

Background: Patients with exercise-induced lower leg pain may suffer from deep posterior chronic exertional compartment syndrome (dp-CECS). Current evidence for the efficacy of surgery is based on retrospective studies. Effects of fasciotomy on symptoms associated with dp-CECS have not been systematically studied, and reasons for unsuccessful surgery are unknown. Purpose: To report the short- and long-term effects of fasciotomy on pain, tightness, and cramps in a prospective cohort of patients with isolated dp-CECS. Study Design: Case series; Level of evidence, 4. Methods: Between September 2011 and January 2015, pain, tightness, cramps, muscle weakness, and diminished sensation were scored (5-item verbal rating scale ranging from very severe [5 points] to absent [1 point]) in patients with dp-CECS before and after fasciotomy. Outcomes were graded as excellent, good, moderate, fair, or poor. Fair and poor cases were again analyzed during a follow-up visit in the outpatient department. Results: Forty-four patients underwent surgery for isolated dp-CECS. Short-term follow-up (median, 4 months; range, 3-7 months) was complete in 42 of the 44 patients (95%; median patient age, 23 years; 23 male; 64 operated legs). Long-term follow-up (median, 27 months; range, 12-42 months) was complete in 34 of 37 eligible patients (92%). Before surgery, exertional pain was very severe (27%) or severe (61%). Fasciotomy improved all symptoms, both in the short term (preoperative vs postoperative pain, 4.1 ± 0.6 vs 2.3 ± 1.1; P < .001) and the long term (pain, 4.2 ± 0.6 vs 2.7 ± 1.3; P < .001). Levels of tightness, cramps, muscle weakness, and diminished sensation demonstrated similar significant improvements. Short- and long-term symptom scores did not differ. The short-term outcome was excellent in 29%, good in 29%, moderate in 21%, fair in 12%, and poor in 10% of patients. In the long term, outcomes were similar (excellent, 12%; good, 35%; moderate, 24%; fair, 18%; and poor, 12%). An unsatisfactory outcome (fair or poor) was often caused by alternative types of CECS (eg, anterior or lateral CECS) or to medial tibial stress syndrome. Based on their outcome, 76% of patients would opt for surgery again. Conclusion: Fasciotomy was beneficial in 71% of patients with dp-CECS in the lower leg; 47% of study patients experienced a good to excellent outcome. Outcomes were stable in the long term. Persistent complaints were often caused by other untreated conditions.

Endoscopic Single Approach Forearm Fasciotomy for Chronic Exertional Compartment Syndrome: Long Term Follow-up

Chronic exertional compartment syndrome of the forearm is an uncommon condition, occurring in some populations such as athletes. The standard surgical treatment for professional athletes who cannot avoid trigger activity is an open forearm fasciotomy, which may require a long recovery time. The aim of this study is to present a new endoscopic single approach forearm fasciotomy technique and outcomes of at least 3 years follow up. We performed the endoscopic single approach forearm fasciotomy in 4 forearms in 3 men with the mean age of 25 years. All of the patients were evaluated at a mean follow up of 46 months using the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. DASH improved from 21.71 to 5.39, VAS score improved too All the patients referred pain absence after the stress test performed at 20 kilos and 40 kilos. In our series no post-operative complications were observed. The new mini-invasive technique has proved to be safe, reliable in a long-term follow-up. The main advantage is the shortening of the recovering time, that leads to a faster return to the professional activity.

Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg.

Surgical release of the anterior and lateral compartments of the lower leg has been shown to relieve the symptoms of chronic exertional compartment syndrome. We utilize a technique that allows the surgeon to perform anterior and lateral compartment fasciotomies through a single incision while safely identifying the superficial peroneal nerve. After positioning the patient supine on the operating table with the operative extremity prepared and draped, anatomic landmarks are identified on the patient's skin. The major steps of the procedure are (1) identifying the distal end of the fibula, anterior fibular diaphysis, tibial crest, fibular head, and lateral aspect of the patella; (2) drawing the skin incision, beginning 6 to 8 cm proximal to the distal end of the fibula centered between the tibial crest and anterior fibular diaphysis and extending it 6 cm proximally; (3) making a skin incision longitudinally and dissecting the subcutaneous tissue to allow identification of the fascia and superficial peroneal nerve; (4) performing gentle neurolysis; (5) identifying the anterior and lateral compartments, making small incisions in the fascia of each compartment, and then performing fasciotomy of the lateral and then anterior compartments while protecting the superficial peroneal nerve; and (6) irrigating the wound, closing it in layers, and applying a soft, compressive dressing. Postoperatively, the patient is allowed to bear as much weight as he or she can tolerate. Current literature indicates that good-to-excellent outcomes can be expected for 90% to 95% of patients treated with fasciotomy. Military personnel and patients with posterior compartment involvement may have less reliable outcomes.

Nonoperative Management of Chronic Exertional Compartment Syndrome: A Systematic Review.

Although nonoperative treatment options for chronic exertional compartment syndrome (CECS) are often used in clinical practice, supporting evidence is limited. The objective of this study was to systematically review the literature for nonsurgical treatment options for CECS of the lower leg. The literature search identified seven articles describing in total four different treatment options: massage, gait changes, chemodenervation, and ultrasound-guided (USG) fascial fenestration. Pertinent studies were in the form of case series and one case report, which limited the robustness of the data. Nevertheless, all four treatment options have little to no reported adverse effect profiles and can be considered in clinical practice. In addition, gait changes and USG fascial fenestration were found to have continued effect at 1 and 1.5 years, respectively.

CHRONIC COMPARTMENT SYNDROME OF LOWER LEG. AN UNUSUAL CASE IN NON ATHLETIC PATIENT

Chronic exertional anterior compartment syndrome is debilitating disease of lower limb. The clinical picture is characterised by limited symptomology at rest, pain during sporting activities, tumefaction and contractures of limb as well impotency by pain of the entire forefoot and hypoesthesia. Usually the most affected patients are athletes. We analyse a case of chronic post traumatic compartment syndrome of the anterior tibial muscle in an unsportsmanlike patient.

Current Concepts Regarding the Diagnosis and Treatment of Chronic Exertional Compartment Syndrome of the Leg

Current Concepts Regarding the Diagnosis and Treatment of Chronic Exertional Compartment Syndrome of the Leg

Isolated Chronic Exertional Compartment Syndrome of the Lateral Lower Leg

Background:Exercise-induced lower leg pain may be caused by chronic exertional compartment syndrome (CECS). The anterior (ant-CECS) or deep posterior compartment (dp-CECS) is usually affected. Knowledge regarding CECS of the lateral compartment (lat-CECS) is limited.Purpose:To describe demographic characteristics and symptoms in a consecutive series of patients with isolated CECS of the lateral compartment of the leg.Study Design:Case series; Level of evidence, 4.Methods:Since 2001, patients undergoing dynamic intracompartmental pressure (ICP) measurements for suspected CECS in a single institution were prospectively monitored. Individuals with a history possibly associated with lat-CECS and elevated ICP measurements (Pedowitz criteria) were identified. Exclusion criteria were concomitant ipsilateral ant-CECS/dp-CECS, acute compartment syndrome, recent significant trauma, peroneal nerve entrapment, or vascular claudication.Results:During an 11-year time period, a total of 26 patients with isolated lat-CECS fulfilled study criteria (15 females; median age, 21 years; range, 14-48 years). Frequently identified provocative sports were running (n = 4), walking (n = 4), field hockey (n = 3), soccer (n = 3), and volleyball (n = 2). Exercise-induced lateral lower leg pain (92%) and tightness (42%) were often reported. The syndrome was bilateral in almost two-thirds (62%, n = 16). Delay in diagnosis averaged 24 months (range, 2 months to 10 years).Conclusion:Young patients with exercise-induced pain in the lateral portions of the lower leg may suffer from isolated CECS of the lateral compartment. ICP measurements in the lateral compartment in these patients are recommended.

Intramuscular Pressure Differs Between Genders in Patients with Chronic Exertional Compartment Syndrome

Intramuscular Pressure Differs Between Genders in Patients with Chronic Exertional Compartment Syndrome

Endoscopic Thermal Fasciotomy for Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome is an activity-induced condition that occurs when intracompartmental pressures within an osteofascial envelope increase during exercise, leading to reversible ischemic symptoms such as pain, cramping, numbness, or weakness. Nonoperative treatment options for this condition have shown limited success and are often undesirable for the patient given the requirement for activity modification. Traditional surgical treatment options involving open or subcutaneous fasciotomies have more favorable results, but these techniques are associated with significant morbidity. Endoscopically assisted fasciotomy techniques afford the advantages of being minimally invasive, providing excellent visualization, and allowing accelerated rehabilitation. The purpose of this article is to describe a technique for performing endoscopically assisted fasciotomies for chronic exertional compartment syndrome of the lower leg using an entirely endoscopic thermal ablating device. The endoscopic thermal fasciotomy technique is associated with minimal morbidity, ensures excellent hemostasis, and affords an early return to sports.

Chronic exertional compartment syndrome of the superficial posterior compartment: Soleus syndrome.

Chronic exertional compartment syndrome (CECS) represents the second most-common cause of exertional leg pain with incidence of 27-33%. CECS of the superficial posterior compartment, or soleus syndrome, is rare and has only been discussed briefly in the literature. We discuss the management of two patients with bilateral soleus syndrome or CECS of the superficial posterior compartment.

Management of chronic exertional compartment syndrome

Background: Post-exercise pain is an uncommon symptom in young, healthy adults. Rest and avoidance of exercise are frequently ineffective and poorly accepted by young, active and otherwise healthy individuals. Methods: A total of 123 patients with extremity muscle pain, swelling and paraesthesia during the last 10 years were evaluated from a prospective database with compartment pressures and selectively evaluated with Doppler ultrasound and angiography. Results: Patients were young (average 28 years) with long duration of symptoms (average 3.5 years), affecting both upper limbs (3), and lower limbs (120), and 80% were bilateral. Eighty-six were male (70%). All of them were taking part either in active sports or exercise programmes, mostly athletics (49%). Common symptoms were isolated muscle pain in the anterolateral compartments in all patients, paraesthesia in 15% and swelling in 10%. Post-exercise mean compartment pressure was 61 mmHg (normal <30 mmHg). Modified open fasciotomies were performed by lateral and medial incisions in lower limbs and by a single incision in upper limbs. Minor complications occurred in 11% of patients. Full relief of symptoms occurred in 90%, 7% had some improvement of symptoms, and treatment failure occurred in 3% of patients. Conclusion: Chronic exertional compartment syndrome is underdiagnosed and should be considered as a potential cause for post-exercise pain in young individuals, and should be treated surgically. Measurement of compartment pressure is important in order to confirm the diagnosis. Open fasciotomy is safe and effective and should be considered as the preferred surgical procedure.

Gait Retraining for Injured and Healthy Runners Using Augmented Feedback: A Systematic Literature Review.

Systematic literature review. This review sought to determine the efficacy of real-time visual and/or auditory feedback for modifying kinematics and kinetics during running gait. Real-time visual and auditory feedback has gained popularity in the clinical and research settings. Rehabilitation time and injury prevention may be improved when clinicians are able to modify running mechanics in a patient population. A thorough search of PubMed, CINAHL, and Web of Science from 1989 to January 2015 was performed. The search sought articles that examined real-time visual or auditory feedback for the purposes of modifying kinematics or kinetics in injured or healthy runners. Study design and methodological quality were rated using a 20-point scale. Ten studies were identified for inclusion in the review, 2 of high and 8 of moderate methodological quality. There was a consensus in the literature that the use of real-time feedback is effective in reducing variables related to ground reaction forces, as well as in positively modifying previously identified risky lower extremity kinematic movement patterns in healthy runners and those with patellofemoral pain and chronic exertional compartment syndrome. No one method of feedback was identified as being superior. Mirror and 2-dimensional video feedback were identified as potential methods for running-gait modification in a clinical setting. In conjunction with traditional therapeutic interventions, real-time auditory and visual feedback should be considered for treating injured runners or addressing potentially injurious running mechanics in a healthy population.

MRI of Musculotendinous Injuries—Part I: “Non-strain” Injuries

Muscle injuries have been consequential since ancient times, but evaluation of such injuries entered a new era with the advent of MRI. The pace of muscle injury research has accelerated in recent years, with new insights on prevention, diagnosis, treatment, and prognosis. This article reviews the current highlights in our understanding of musculotendinous injuries diagnosed by MRI, particularly: (1) direct injuries and their sequelae (e.g., contusion, hematoma, heterotopic ossification, muscle herniation, and chronic exertional compartment syndrome); (2) characteristic manifestations of tensile injuries in children at the apophysis and adults at areas of tendinopathy; and (3) differential diagnostic considerations for abnormal signal intensity seen on MRI.

Endoluminal minimally invasive surgery for chronic exertional compartment syndrome: A new technique

IntroductionFasciotomy is the usual treatment for chronic exertional compartment syndrome of the lower limb. For esthetic reasons, minimally invasive techniques have been developed but can generate complications. Herein, we report the use of the KnifeLight during minimally invasive anterior and lateral compartment release in view of reducing these complications, within a feasibility study. Material and methodsThis study was conducted on four cadavers (eight legs) and then an athletic patient (two legs). ResultsThe technique was carried out on all cases with no complications. The patient's result was excellent. DiscussionThe KnifeLight can be used to perform a fasciotomy of the leg's anterior and lateral compartments. It seems to provide the operator with additional safety compared to other minimally invasive techniques. ConclusionThis is a simple, reliable, and reproducible technique that deserves to be better known.