Lower Leg Chronic Exertional Compartment Syndrome in Patients 50 Years of Age and Older

Background: Lower leg chronic exertional compartment syndrome (CECS) is usually diagnosed in young and athletic individuals. The presence of CECS in older patients has received little attention in the literature, and patient characteristics are unknown. Purpose: To determine the prevalence of CECS in older patients (≥50 years) and to assess whether older patients with CECS differ clinically from younger patients with CECS. Study Design: Cohort study; Level of evidence, 3. Methods: All individuals with exercise-induced lower leg pain who visited a referral center for CECS between January 2001 and December 2013 were eligible for analysis. Patients were included if history, physical examination, and dynamic intracompartmental pressure measurement indicated CECS. Characteristics of patients 50 years of age or older were compared with characteristics of patients younger than 50. Results: A total of 698 patients with CECS were included: 98 patients were aged 50 years or older and 600 patients were younger than 50 years. Older individuals more often reported a history of lower leg events or comorbidities (≥50 years, 45% vs <50 years, 25%; P < .01) and unilateral symptoms (≥50 years, 45% vs <50 years, 22%; P < .01). Most older patients (62%) did not participate in sport or only walked or hiked, whereas the same was true of only 7% of the younger population. Pain (≥50 years, 94%; <50 years, 96%) and tightness (≥50 years, 57%; <50 years, 62%) were the predominant symptoms of CECS in both groups. Type of CECS differed significantly ( P < .01); the anterior muscle compartment was involved more frequently in older patients (≥50 years, 82% vs <50 years, 59%) and deep flexor muscle CECS was more often diagnosed in younger patients (≥50 years, 26% vs <50 years, 53%). Conclusion: In the present population, 1 in 7 patients diagnosed with lower leg CECS was 50 years of age or older. These individuals were less active and had more comorbidities than patients younger than 50 years. Older individuals predominantly have anterior CECS. Clinicians should consider CECS in older individuals with exercise-induced lower leg pain, particularly if it is unilateral.

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Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population

International Journal of Sports Medicine ◽

10.1055/s-0043-119225 ◽

2017 ◽

Vol 39 (01) ◽

pp. 58-66 ◽

Cited By ~ 14

Author(s):

Johan de Bruijn ◽

Aniek van Zantvoort ◽

David van Klaveren ◽

Michiel Winkes ◽

Marike van der Cruijsen-Raaijmakers ◽

...

Keyword(s):

Compartment Syndrome ◽

Predictive Model ◽

Pressure Measurement ◽

Large Population ◽

Lower Leg ◽

Leg Pain ◽

Intracompartmental Pressure ◽

Discriminative Ability ◽

Chronic Exertional Compartment Syndrome ◽

Exertional Compartment Syndrome

AbstractKnowledge about lower leg chronic exertional compartment syndrome (CECS) is largely obtained from highly selected populations. Patient characteristics may therefore not be appropriate for the general population. Our purpose was to describe a heterogeneous population of individuals suspected of lower leg CECS and to identify predictors of CECS. Charts of individuals who were analyzed for exercise-induced lower leg pain in a referral center between 2001 and 2013 were retrospectively studied. Patients were included if history and physical examination were suggestive of CECS and if they had undergone a dynamic intracompartmental pressure measurement. Six hundred ninety-eight of 1411 individuals were diagnosed with CECS in one or more of three lower leg muscle compartments (anterior tibial, deep flexor, lateral). Prevalence of CECS peaked around the age of 20–25 years and decreased thereafter, although a plateau around 50 years was found. Age, gender, bilateral symptoms, previous lower leg pathology, sports (running and skating) and tender muscle compartments were identified as independent predictors of lower leg CECS. The proposed predictive model has moderate discriminative ability (AUC 0.66) and good calibration over the complete range of predicted probabilities. The predictive model, displayed as a nomogram, may aid in selecting individuals requiring an invasive dynamic intracompartmental muscle pressure measurement.

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Chronic exertional compartment syndrome: diagnosis, investigation, management and return to training

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-104-124 ◽

2018 ◽

Vol 104 (2) ◽

pp. 124-128

Author(s):

R L Thomas ◽

R Hemingway ◽

A Keenan ◽

A Wood

Keyword(s):

Compartment Syndrome ◽

Lower Limbs ◽

Leg Pain ◽

Military Recruit ◽

Chronic Exertional Compartment Syndrome ◽

Military Recruits ◽

Exertional Compartment Syndrome ◽

Poor Outcomes ◽

Exercise Induced ◽

The Military

AbstractExercise-induced leg pain is a frequent presenting complaint in military recruits. This has several causes, including chronic exertional compartment syndrome (CECS). The pathophysiology of CECS is debated, but it involves pressure increases in particular compartments and reduced compliance in the epimyseal fascia. Its morbidity and poor outcomes with conservative management lead to extended rehabilitation times, and ultimately to a loss of recruits from training. It has been described in various compartments of the upper and lower limbs, but is most frequently encountered in the leg. It is a condition often encountered in the military recruit, and within this demographic is less common than other causes of exertional lower leg pain. However, its debilitating nature and complicated investigative pathway can cause difficulties, and have notable occupational consequences. This article aims to review the evidence surrounding its diagnosis, treatment, prognosis and the implications for the military patient.

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Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

International Journal of Sports Medicine ◽

10.1055/a-0640-9104 ◽

2018 ◽

Vol 39 (14) ◽

pp. 1081-1087 ◽

Cited By ~ 4

Author(s):

Aniek van Zantvoort ◽

Johan de Bruijn ◽

Henricus Hundscheid ◽

Marike van der Cruijsen-Raaijmakers ◽

Joep Teijink ◽

...

Keyword(s):

Compartment Syndrome ◽

Lateral Compartment ◽

Lower Leg ◽

Leg Pain ◽

Success Rates ◽

Intracompartmental Pressure ◽

Surgical Success ◽

Chronic Exertional Compartment Syndrome ◽

Exertional Compartment Syndrome

AbstractExercise-induced lower leg pain may be caused by chronic exertional compartment syndrome (CECS). Anterior or deep posterior compartments are usually affected. Knowledge about CECS of the lateral compartment (lat-CECS) is limited and outcome after fasciotomy is unknown. The purpose of this study is to report on success rates of fasciotomy in patients with lat-CECS. Surgical success rates in patients with lat-CECS diagnosed with a dynamic intracompartmental pressure (ICP) measurement were studied using a questionnaire (success: excellent or good as judged by the patient; unsuccessful: moderate, fair or poor). We conducted ICP measurements in 247 patients for suspected lat-CECS, of whom 78 were positively diagnosed. Following exclusion (n=11), 30 of the eligible 67 patients completed the questionnaire. Bilateral (70%, n=21/30) exertional pain (97%, n=29) and a feeling of tightness (93%, n=28) were the most frequently reported symptoms. Four years after fasciotomy, severity and frequency of symptoms had dropped significantly. Long-term surgical success was reported by 33% (n=10; excellent n=4, good n=6). Seventy-three percent (n=22) had resumed sports activities (9 same level, 13 lower level). In conclusion, a fasciotomy for lat-CECS was successful in the long term in just one of three operated patients in this retrospective study.

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Chronic compartment syndrome also affects nonathletic subjects: A prospective study of 63 cases with exercise-induced lower leg pain

Acta Orthopaedica ◽

10.1080/17453670610013547 ◽

2007 ◽

Vol 78 (1) ◽

pp. 136-142 ◽

Cited By ~ 59

Author(s):

David Edmundsson ◽

Göran Toolanen ◽

Peter Sojka

Keyword(s):

Prospective Study ◽

Compartment Syndrome ◽

Lower Leg ◽

Leg Pain ◽

Chronic Compartment Syndrome ◽

Exercise Induced ◽

A Prospective Study ◽

Lower Leg Pain

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Chronic Exertional Compartment Syndrome in Athletes: A narrative Review

Sports & Exercise Medicine Switzerland ◽

10.34045/sems/2020/17 ◽

2020 ◽

Keyword(s):

Compartment Syndrome ◽

Popliteal Artery ◽

Vascular System ◽

Lower Leg ◽

Leg Pain ◽

Chronic Exertional Compartment Syndrome ◽

Profound Knowledge ◽

Popliteal Artery Entrapment ◽

Exertional Compartment Syndrome ◽

Interdisciplinary Thinking

Chronic exertional compartment syndrome of the lower leg accounts for approximately 75% of sports-related chronic leg pain. Nevertheless, the exact and timely recognition in athletes might pose a great challenge to sports physicians. Among a variety of possible differential diagnoses such as tenosynovitis, stress fractures, periostalgia, or popliteal artery entrapment syndrome the physician has to be able to identify the correct entity as promptly as possible. Consequently, profound knowledge about exercise-associated pathologies of the musculoskeletal, nervous and vascular system, as well as the capability of interdisciplinary thinking are critical.

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Minimally invasive fasciotomy using a lighted retractor in the treatment of chronic exertional compartment syndrome

Journal of Orthopaedic Surgery ◽

10.1177/2309499019892800 ◽

2019 ◽

Vol 28 (1) ◽

pp. 230949901989280

Author(s):

James M Broderick ◽

Keith A Synnott ◽

Kevin J Mulhall

Keyword(s):

Compartment Syndrome ◽

Leg Pain ◽

Direct Visualization ◽

Chronic Exertional Compartment Syndrome ◽

Exertional Compartment Syndrome ◽

Subcutaneous Tissues ◽

Direct Nerve ◽

Lower Leg Pain ◽

Subcutaneous Plane ◽

Mini Open

Chronic exertional compartment syndrome can be a debilitating cause of lower leg pain that typically affects young, healthy people during a variety of aerobic activities. Conservative management has produced a poor success rate and numerous techniques for surgical decompression have been described. Many of these, however, involve blind fascial dissection which increases the risk of direct nerve injury or insufficient fascial release. We describe a novel technique of mini-open fasciotomy using a lighted retractor which enables direct visualization of the fascia and the superficial peroneal nerve using a single, small incision. By the use of a 3- to 4-cm laterally based incision, a lighted retractor with fiber-optic illumination is introduced into the subcutaneous plane and advanced distally and proximally. The retractor gently elevates the subcutaneous tissues while focusing light directly into the surgical area and a long Metzenbaum scissors is then used to release the fascia under direct vision. Fasciotomy using this technique avoids the risks of blind fascial release and is a straightforward, safe, and effective method for compartment decompression.

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Exercise induced neuropathic lower leg pain due to a tibial bone exostosis

The Physician and Sportsmedicine ◽

10.1080/00913847.2021.1910006 ◽

2021 ◽

Author(s):

van den Hurk Loreen ◽

van den Besselaar marijn ◽

Scheltinga Marc R

Keyword(s):

Lower Leg ◽

Leg Pain ◽

Tibial Bone ◽

Exercise Induced ◽

Lower Leg Pain

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Shin-splints: Common exercise-related syndromes affecting the lower leg

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-100-272 ◽

2014 ◽

Vol 100 (3) ◽

pp. 272-276

Author(s):

BL Williamson ◽

CHC Arthur

Keyword(s):

Soft Tissues ◽

Lower Leg ◽

Leg Pain ◽

Shin Splints ◽

Common Complaint ◽

Acute Injuries ◽

Exertional Compartment Syndrome ◽

As Stress ◽

Lower Leg Pain ◽

The Military

AbstractLower leg pain is a common complaint of athletically active individuals, often limiting physical activities. As such, the group of lower leg conditions related to athletic pursuits and physical exercise confer considerable operational implications for the military. Whilst acute injuries to the lower limb are commonly encountered and are clearly of significance, this article focuses instead on chronic conditions related to physical activity. These include insults to bone such as stress fractures and medial tibial stress syndrome, and those related to the soft tissues such as chronic exertional compartment syndrome. In this article we will examine the presentation and management of these conditions.

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