UMEM Educational Pearls

Category: Orthopedics

Title: Chronic Exertional Compartment Syndrome (CECS)

Keywords: pressure, exercise, lower extremity (PubMed Search)

Posted: 8/14/2021 by Brian Corwell, MD (Updated: 8/11/2022)
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Chronic Exertional Compartment Syndrome (CECS)

 

Similar pathology to acute compartment syndrome except symptoms are related to activity (frequently running) and abate with rest.

95% involve lower extremity

Inappropriately elevated tissue pressure in one or more lower leg compartments associated with exercise

Anterior compartment most frequently involved

As tissue pressure increases, local perfusion is decreased. This leads to symptoms of pain, pressure, cramping and paresthesias.  

Also commonly associated with team sports such as soccer, lacrosse and field hockey.

More likely in competitive athletes than recreational.

Patient will be symptom free at time of ED evaluation

Make diagnosis of CECS with history

  1. Pain must be induced with exercise
  2. Usually limited to a single compartment, frequently the anterior
  3. Pain occurs at predictable time in exercise and forces athlete to stop running
  4. Pain resolves with rest
  5. If witnessed, tenderness is present only in the involved compartment and not elsewhere

Diagnosis with compartment pressure measurements done in office with treadmill exercise.

Non operatively, gait retraining programs have been shown to help symptoms. Appropriate if symptoms are mild.

Surgical treatment involves a minimally invasive fasciotomy

Post surgery success rates are between 63-100% with recurrence rates up to 20%