<p>Chronic exertional compartment syndrome: current management strategies</p>

Abstract

Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. Needle manometry can be used to confirm diagnosis of CECS by measuring intracompartmental pressure. Operative treatment of CECS with fasciotomy has been shown to be effective in resolution of CECS, and new surgical techniques are being developed. In the pediatric population, endoscopy-assisted compartment release has provided high success rates with low complication rates. Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. Nonetheless, larger samples and a more diverse population are needed to better understand the outcomes of nonoperative management. There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

MR diagnosed chronic exertional compartment syndrome successfully treated by endoscopically-assisted fasciotomy

“…Nonoperative management of CECS initially consists of cessation of the physical activity inciting patient symptoms; however, patients are usually reluctant to give up their routine activity [22] . Patients that received surgery for their CECS had a higher post-treatment satisfaction rate than those using nonoperative treatment plans [23] .…”

“…Patients that received surgery for their CECS had a higher post-treatment satisfaction rate than those using nonoperative treatment plans [23] . Operative management options for CECS in the lower extremity include open fasciotomy, single incision fasciotomy, percutaneous fasciotomy, and endoscopy-assisted-compartment release [22] . Lohrer and Nauck described the use of endoscopic fasciotomy in 17 athletes with CECS [22 , 24] .…”

“…Operative management options for CECS in the lower extremity include open fasciotomy, single incision fasciotomy, percutaneous fasciotomy, and endoscopy-assisted-compartment release [22] . Lohrer and Nauck described the use of endoscopic fasciotomy in 17 athletes with CECS [22 , 24] . In these patients, the technique was performed on 19 deep posterior compartments [22 , 24] .…”

Dual-incision minimally invasive fasciotomy of the anterior and peroneal compartments for chronic exertional compartment syndrome of the lower leg

“…This is because they have shown low recurrence rates and allow a faster return to sports activities 7 , 8 . The literature heavily focused on techniques for decompression of the anterior compartment, as it is assumed that the anterior compartment of the leg is most frequently affected 9 , 10 .…”

Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study

“…5,13 The anterior compartment of the leg has been thought to be most commonly affected, and the literature has been heavily focused on techniques to decompress this compartment. 2,4 Recent studies have suggested that deep posterior compartment CECS (dp-CECS) is often overlooked, and its incidence may be higher than anticipated. 22,23 Traditionally, skin and fascial incisions for lower limb fasciotomy have been longitudinal, although some recent studies have demonstrated that transverse incisions may be a suitable alternative.…”