Chronic Exertional Compartment Syndrome in ­Athletes: A narrative Review

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.

scholarly journals Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome?

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Christopher Gaunder ◽  
Brandon McKinney ◽  
Jessica Rivera
Keyword(s):  
Compartment Syndrome ◽  
Popliteal Artery ◽  
Young Athlete ◽  
Leg Pain ◽  
Limb Pain ◽  
Chronic Exertional Compartment Syndrome ◽  
Presenting Symptoms ◽  
Lower Limb Pain ◽  
Popliteal Artery Entrapment ◽  
Exertional Compartment Syndrome

Diagnosis of lower limb pain in an athlete can be a challenging task due to the variety of potential etiologies and ambiguity of presenting symptoms. Five of the most commonly encountered causes of limb pain in athletes are chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), tibial stress fractures, soleal sling syndrome, and popliteal artery entrapment syndrome (PAES). Of these, the least frequent but potentially most serious of the pathologies is PAES. With an incidence of less than 1% seen in living subject studies, the condition is rare. However, a missed diagnosis will likely lead to progression of the disease and potential for unnecessary invasive procedures (McAree et al. 2008). In this paper, we present a young athlete misdiagnosed and treated for chronic exertional compartment syndrome. In both descriptive and a quick-reference table format, we review current literature and discuss how best to distinguish functional PAES from other causes of activity-related leg pain.

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

2017 ◽  
Vol 39 (01) ◽  
pp. 58-66 ◽  
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.

scholarly journals Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

2018 ◽  
Vol 39 (14) ◽  
pp. 1081-1087 ◽  
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.

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

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711875717 ◽  
Author(s):  
Johan A. de Bruijn ◽  
Aniek P.M. van Zantvoort ◽  
Michiel B. Winkes ◽  
Marike van der Cruijsen-Raaijmakers ◽  
Adwin R. Hoogeveen ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Older Patients ◽  
Lower Leg ◽  
Leg Pain ◽  
Older Individuals ◽  
Younger Patients ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Exercise Induced ◽  
Lower Leg Pain

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.

scholarly journals Popliteal artery entrapment syndrome misdiagnosed as chronic exertional compartment syndrome in a young male athlete: Role of dynamic ultrasound

1970 ◽  
Vol 24 (2) ◽  
Author(s):  
Z Oschman ◽  
E Metherell
Keyword(s):  
Compartment Syndrome ◽  
Popliteal Artery ◽  
Young Male ◽  
Male Athlete ◽  
Chronic Exertional Compartment Syndrome ◽  
Entrapment Syndrome ◽  
Popliteal Artery Entrapment Syndrome ◽  
Popliteal Artery Entrapment ◽  
Exertional Compartment Syndrome ◽  
Dynamic Ultrasound

Popliteal artery entrapment syndrome (PAES) is an uncommon cause of exercise-induced pain in the lower extremity of young athletes. However, it might explain the symptoms of those athletes who do not respond to treatment for the more common overuse syndromes. We present a case of a young professional male athlete who was diagnosed with bilateral chronic exertional compartment syndrome (CECS), for which he was operated on twice. His symptoms persisted for 5 years before PAES was diagnosed withdynamic ultrasound, and after bilateral surgical release a few months apart, he was completely symptom-free except for some discomfort in the fasciotomy scars.

scholarly journals Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

2020 ◽  
Vol 30 (10) ◽  
pp. 1827-1845
Author(s):  
Sanne Vogels ◽  
Ewan D. Ritchie ◽  
Thijs T. C. F. Dongen ◽  
Marc R. M. Scheltinga ◽  
Wes O. Zimmermann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Compartment Syndrome ◽  
Lower Leg ◽  
Chronic Exertional Compartment Syndrome ◽  
Outcome Parameters ◽  
Exertional Compartment Syndrome

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

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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