Chronic Exertional Compartment Syndrome

Chronic Exertional Compartment Syndrome

Pathophysiology:
Chronic exertional compartment syndrome (CECS) is a condition in which patients experience pain with exercise that usually subsides with resting. It refers to us that increased in blood pressure within the closed fibro osseous space that leads to reduced blood flow causes the ischemic pain and damage to the tissue. CECS observed usually observed in competitive or collegiate athletes; long-distance runners, basketball players, skiers, and soccer players. This is usually relieved by discontinuing the exercise, and is usually not dangerous. CECS is most commonly described in the leg, accounting for more than 95% of all cases. However, other investigators have variably reported involvement of the hand forearm, thigh and foot in narrow high-risk cohorts. CECS is the second-leading cause of exertional leg pain after medial tibial stress syndrome (MTSS), with a prevalence of up to one-third of athletes. The differential diagnosis evaluations for nerve entrapment, stress fracture, deep vein thrombosis, and other clinical entities.

Treatment:
Chronic exertional compartment syndrome treatment can be through by either by surgical or non-surgical. The non-surgical can be Physical therapy, orthotics (inserts for shoes) and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms. Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artificial turf vs. grass). Symptoms may be relieved by switching surfaces. If the conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell.

Major research on disease:
An athlete can have reoccurrence of compartment syndrome after having a fasciotomy. The rate of reoccurrence is 6–11%, most patients, who fail treatment initially, have resolution of symptoms with a second more extensive fasciotomy. As insights are gained into the etiology of compartment syndrome pain, a greater diversity of treatment options for CECS will be available. The only definitive treatment currently is fasciotomy. Improved awareness of CECS by both providers and athletes may result in earlier intervention and a higher success rate of conservative therapy.