Fasciotomy for chronic compartment syndrome in the lower limb

Abstract

Surgical decompression is the accepted treatment of compartment syndrome as proven by pressure manometry, after failure of conservative treatment.

Chronic exertional compartment syndrome of the leg

“…CECS should be suspected in any athlete who presents with chronic anterior leg pain which worsens with prolonged use and resolves upon cessation of activity. 95% of cases of CECS occur in the anterior and lateral compartments of the leg [5,8,14,32]. In select groups of athletes, other potential locations of CECS include the superficial and deep posterior compartments of the lower leg, as well as, the compartments of the thigh and forearm [4,12].…”

“…In select groups of athletes, other potential locations of CECS include the superficial and deep posterior compartments of the lower leg, as well as, the compartments of the thigh and forearm [4,12]. CECS occurs most commonly in young adult recreational and elite runners, military recruits, and athletes who participate in ball and puck sports [2,8,25]. There have been no demonstrated differences in the incidence in men and women [27,28].…”

“…Physical exam finding of CECS are pain on palpation of the muscles involved, pain with passive stretching of the muscle, and firmness of the involved compartments. Muscle herniation through defects in fascia can be palpated in 40-60% of patients with the syndrome [8,10,26]. The herniated muscle is normally palpated over the anterior tibia.…”

“…Because there is an average 2 year delay in the diagnosis of CECS, conservative methods are often implemented late with low success rates. The conservative treatment methods, which have been noted in case studies to have the most success, consist of discontinuing the activity that elicits symptoms or decreasing the intensity of training [7,8,21]. For example, a runner can become a cyclist because cycling has a lower risk of compartment syndrome.…”

“…A classic history is development of pain in a compartment of the leg at the same time, distance, or intensity of exercise [8,28]. The pain increases in intensity as the patient continues exercising.…”