Chronic exertional compartment syndrome (CECS)

Chronic exertional compartment syndrome (CECS)

It is a compartment syndrome - the tibialis anterior muscle swells with exercise producing relative muscle ischaemia as the muscle expansion is restricted by the non expansile fascial compartment - may be numbness of the big toe.

• CECS may be difficult to diagnose, but it is most commonly affects the anterior compartment

Anterior compartment of lower leg (1):

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• CECS is a condition of increased pressure in the fascial compartments (muscles and neurovascular structures bound by fascia and bone) related to exercise leads to recurrent episodes of pain
  • symptoms are bilateral 85% to 95% of the time
  • pathophysiology of CECS is multifactorial. Factors may include (2,3,4):
    • constraints of a fixed muscular compartment, normal or abnormal muscle swelling that occurs with activity, abnormally thickened fascia, normal muscle hypertrophy in response to resistance training, or dynamic contraction patterns during gait
    • low muscle capillary supply is a pathogenic factor in chronic compartment syndrome
      
      
• CECS is prevalent equally in both sexes with a median age of onset of 20-years-old and is associated with diabetes mellitus

CECS: Compartment Pressure Testing (5)

• compartment pressure testing is the gold standard for CECS
  • pre-exertional and post-exertional measurements are needed
  • the post-exertional measurements should be taken within 5 minutes of the exercise; the athlete should be symptomatic at the time of measurement
  • a positive compartment pressure test is a pre-exercise resting pressure of 15 mmHg or greater and/or a 1-minute postexercise pressure of 30 mmHg or greater and/or a 5-minute postexercise pressure of 20 mmHg or greater

Reference:

1. Faez M. The anatomy of the leg. SlideShare.
2. Brennan FH, Kane SF. Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome. Curr Sports Med Rep. 2003;2:247-250
3. Raikin S, Venkat R, Vitanzo P. Bilateral simultaneous fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int 2005; 26: 1007-1011
4. Shah S, Miller B, Kuhn J. Chronic exertional compartment syndrome. Am J Orthop 2004; 33: 335-341
5. Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990;18:35-40.