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Chronic Exertional Compartment Syndrome of the Lower Extremity: Diagnosis, Management, and Surgical Technique

March 01, 2017

Contributors: Amos Dai, BS; Kirk A Campbell, MD; Guillem Gonzalez-Lomas, MD; Laith M Jazrawi, MD; Daniel James Kaplan, BA; Stephanie Swensen, MD; Michelle Yagnatovsky; Warren Young, MD

Purpose: Chronic exertional compartment syndrome (CECS) is a disorder that is commonly seen in athletes and is associated with repetitive exertion. It is due to increased pressure in the fibrosseus space. This pressure leads to decreased tissue perfusion and ischemic pain. The lower leg is composed of four compartments: anterior, lateral, deep posterior, and superficial posterior. Compartment syndrome most commonly occurs in the anterior compartment. We review the important structures contained in each of the four compartments. CECS is often refractory to conservative measures unless the inciting activity is completely ceased. The purpose of this video is to describe the diagnosis and workup of CECS and demonstrate surgical technique of fasciotomy used to treat it. Methods: We present a series of three cases. The first case is of a 19-year-old female soccer player with bilateral calf pain for 1.5 years. Pain is exacerbated by exercise and relieved by rest. Compartment recordings showed elevated pressures at baseline without elevation after exercise. The next case is of a 28-year-old male with worsening leg pain on ambulation. Pain is present both at rest and with exercise. Compartment recordings revealed elevated pressures at both one minute and 15 minutes post-exercise. Our third case deals with a potential sequela of compartment syndrome: muscle hernias. These are herniations of muscle through fascial defects. This case is of a 21-year-old male with progressively worse leg pain on ambulation and history of two right lower extremity hernias of the peroneus longus tendon. In all three cases, four compartment fasciotomies are performed. Results: Excellent clinical results are noted, both in these cases and in the literature. Physical therapy is initiated at two weeks after surgery and return to sports can be made at six weeks. Conclusion: Chronic exertional compartment syndrome is an uncommon but often unrecognized source of chronic extremity pain in the athletic patient. Careful history and physical exam, along with appropriate diagnostic testing, is necessary to come to the correct diagnosis. Nonoperative treatment is rarely effective unless the inciting activity is completely stopped. Surgical fasciotomy leads to good results and return to function.

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