Bilateral Compartment Syndrome of the Anterior Thigh Following Functional Fitness Exercises: A Case Report

Abstract

We present a case of delayed, acute bilateral exertional compartment syndrome of the anterior thigh induced by callisthenic exercise. Symptoms consisted of pain out of proportion to examination findings, inability to ambulate, and severe pain with knee flexion. Treatment consisted of bilateral thigh fasciotomies and supportive therapy for concomitant rhabdomyolysis. Full strength, range of motion, and return to all military duties were achieved by 4 months postinjury.

Acute exertional compartment syndrome: A case series and review of the literature

“…Their patient recovered with no residual deficits to the affected leg. In contrast, reports documenting acute exertional compartment syndrome of the thigh 3,11 , paraspinal musculature 8,13 , forearm 5,7,15 and foot 6,17 all show universally good outcomes following fasciotomy.…”

“…18 Acute compartment syndrome is a rare diagnosis when not associated with trauma. There have been few case reports of compartment syndrome being caused by prolonged and sustained physical activity [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . These reports include cases in the leg, thigh, forearm, foot and paraspinal musculature.…”

“…In rare cases, acute compartment syndrome can develop outside the setting of trauma, but rather, in the setting of a repetitive exertional mechanism. Intense and sustained physical activity is reported in the literature through case reports as a cause of this syndrome [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Because of the atypical presentation, these patients can often go undiagnosed, leading to muscle necrosis and a significant loss of function, particularly in the lower extremities 4,7,10,14 .…”

Bilateral atraumatic acute anterior compartment syndrome of the legs with rhabdomyolysis and acute kidney injury

“…Subsequently, several reports appeared that described exercise induced ACS causing muscle necrosis, usually in soldiers or athletes, termed 'march myositis' [5,6]. However, exercise induced bilateral ACS is extremely rare with only a handful of reported cases [7].…”

Chemotherapy and extreme exercise: A potentially dangerous combination

“…[2] Although extreme exertion can lead to rhabdomyolysis, ACS of the bilateral anterior thighs after exercise is exceedingly rare, and only several case reports exist in the current literature. In reviewing five of these cases, all patients were male and previously physically fit, [2][3][4][5][6] two patients were in the military, [2,4] and one patient died from metabolic derangements. [2] In all cases, patients presented > 24 h after extreme physical exertion, [2][3][4][5][6] suggesting that patients with this condition may present in a delayed fashion.…”