Chronic exertional compartment syndrome

Prevalence depends on the population studied Runners and endurance athletes have a higher risk than sedentary populations or those who engage in upper extremity dominant sports. 1 In a prospective study of exercise active people (not formally defined as athletes) who had exercise induced leg pain, 49% were diagnosed as having the syndrome. 2 In a case series of athletes with exercise induced leg pain, the incidence of pressure confirmed CECS was 27% 3 People with diabetes may be at increased risk, even with minimal exertional activity 2 Prevalence is similar in men and women, and median age of onset is about 20 years 4 What is CECS? [...]CECS may co-occur with other diseases, including stress fractures or medial tibial stress syndrome (tenderness over the posterior medial border of the tibia related to traction from muscular attachments or diffuse overuse of periosteum and medial border of tibia), which can make diagnosis more difficult. 6 The diagnosis may also be missed owing to overuse of the non-specific label of "shin splints." Key points Patients typically have no pain at rest but develop pain after a set duration and intensity of activity; symptoms subside with a short period of rest Tenderness is usually elicited in the middle of the muscle compartment, not on the bone; pain near the bone should alert the clinician to alternative or associated diagnoses, such as tibial stress fractures or medial tibial stress syndrome If chronic exertional compartment syndrome (CECS) is suspected, obtain intracompartmental pressure measurements at rest and after exertion For patients with confirmed CECS and no associated problems, conservative treatment rarely allows the athlete to return to competition. 13 Van den Brand JG, Nelson T, Verleisdonk EJ, van der Werken C. The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and near-infrared spectroscopy in chronic exertional compartment syndrome: a prospective study in 50 patients.