Nonoperative Management of Chronic Exertional Compartment Syndrome

Abstract

Although nonoperative treatment options for chronic exertional compartment syndrome (CECS) are often used in clinical practice, supporting evidence is limited. The objective of this study was to systematically review the literature for nonsurgical treatment options for CECS of the lower leg. The literature search identified seven articles describing in total four different treatment options: massage, gait changes, chemodenervation, and ultrasound-guided (USG) fascial fenestration. Pertinent studies were in the form of case series and one case report, which limited the robustness of the data. Nevertheless, all four treatment options have little to no reported adverse effect profiles and can be considered in clinical practice. In addition, gait changes and USG fascial fenestration were found to have continued effect at 1 and 1.5 years, respectively.

Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up

“…A clinical description of CECS is repetitive pain and pathologically elevated pressure in a muscular compartment during physical exercise, which returns to normal with cessation of exercise 1. CECS can present in any muscular compartment of the human body, but is most prevalent in the anterior compartment of the leg (anterior CECS) 2. The incidence of CECS in the USA armed forces is estimated at 0.49 cases per 1000 person years (4100 cases diagnosed in 5 years) 3…”

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

“…In addition, gait retraining and shoe modifications may be tried. 11,12 Surgical intervention entails opening of the enveloping fascia via a fasciotomy using an open, a minimally invasive, or an endoscopic technique. [12][13][14] Traditionally, management of CECS starts with conservative measures, followed by surgical intervention in case of treatment failure or severely disabling symptoms.…”

Overuse injuries in the athlete

“…While a number of non-surgical therapeutic interventions have been suggested, none have high-level evidence to support them, with the exception of cessation of the inciting activity. 24,25 If this is not acceptable, fasciotomy can be considered.…”