Without treatment, it can lead to permanent muscle damage. It can occur with any elevation in interstitial pressure in a closed osseofascial compartment. Surgery is required with a procedure called a fasciotomy, in which an incision is made into the skin and fascia that. Exercise induced compartment syndrome in a professional. Chronic compartment syndrome in the lower leg can be treated conservatively or surgically. Such conditions constitute 66% of reported cases of musculoskeletal complaints in the uk. Pdf chronic exertional compartment syndrome of the forearm. Pdf management of chronic exertional compartment syndrome. Compartment syndrome can be defined as increased tissue pressure within a closed myofascial space, resulting in disturbed microcirculation and the potential for irreversible neuromuscular ischaemic damage. Compartment syndrome is a relatively common disorder whereby pressure in one or more muscle compartments. Chronic compartment syndrome ccs is is a common injury in young athletes, causing pain in the involved leg compartment during strenuous exercise. Chronic compartment syndrome usually occurs in young people who do regular repetitive exercise, such as running or cycling.
Very rarely is excessive exercise the underlying cause. Chronic exertional compartment syndrome after minor injury to the. Acute syndromes may complicate fracture, soft tissue trauma, burns, and drug overdose. Compartment syndrome comes in many types, including abdominal, acute, exertional, anterior, lateral, and chronic. Anyone can develop the condition, but its more common in young adult runners and athletes who participate in activities that involve repetitive impact. Open 4compartment fasciotomy for chronic exertional. Acute and chronic compartment syndrome occurs when there is increased tissue pressure within a tight fascial compartment, impairing nervous tissue. Chronic exertional compartment syndrome most often occurs in the lower legs, but occasionally occurs in the thighs, upper arms, forearms and hands. Rehabilitation guidelines following compartment syndrome release with open fasciotomy 333 38th st. Chronic exertional compartment syndrome is characterized by exertional pain and ele vated intracompartmental pressures affecting the leg in physically active young people. Dec 05, 2018 chronic exertional compartment syndrome is an exerciseinduced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms.
Jan 23, 2015 chronic exertional compartment syndrome. Study data are sparse for conservative treatments, which seem largely unsuccessful in common clinical experience. Patients with compartment syndrome exhibit a consistent, predictable and reproducible trajectory of symptoms during physical activity. While the postop dressing is in place, icing should be done continuously. Use athletic shoe inserts orthotics or wear better athletic shoes. Rehabilitation guidelines following compartment syndrome release with open fasciotomy chronic exertional compartment syndrome cecs is a painful condition of the lower leg that affects many runners and other athletes involved in repetitive impact activities. A leading theory is that its caused by temporary swelling of the muscles during exercise affecting the blood supply to a whole group of muscles. Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. As an example, if the compartment syndrome is in the lower leg, raise your toes toward your nose for a count of 30 seconds. Often times, a physical exam is unremarkable and does not reveal if compartment syndrome is the culprit of chronic lower leg pain. Feb 26, 2019 compartment syndrome can occur in the legs, feet, arms or hands. Postoperative instructions fasciotomy for chronic exertional. Evaluation, diagnosis, and treatment of chronic exertional compartment.
Chronic compartment syndrome can result in nerve and muscle damage as well, but less often than the acute form. Chronic exertional compartment syndrome cecs presents with recurrent pain related to exercise. Once the dressing is removed, ice is applied for 20minute periods 34 times per day. Compartment syndrome management and treatment cleveland clinic. Acute compartment syndrome has been well documented clinically. Cleveland ohio internist doctors physician directory compartment syndrome acute or chronic symptoms include pain, numbness, change in sensation, bruising, and paralysis. Compartment syndrome management and treatment cleveland. Eightytwo per cent of these are attributed to repetitive work, mostly keyboard work. Braver, dpm patients who experience intense pain, a burning sensation, tightness, andor numbness in the lower extremities during exercise activity, whereby the pain resolves quickly after cessation of activity, can often be diagnosed with chronic exertional compartment syndrome cecs. Although the incidence of cecs in the general population is unknown, it was determined to be 0. For chronic compartment syndrome, relax the muscles of the affected limb by lightly stretching. Cecs is caused by increased intracompartmental pressure within a fascial space. There are two types of compartment syndrome acute and chronic. Chronic exertional compartment syndrome cecs presents with recurrent pain related to.
Patients with compartment syndrome exhibit a consistent, predictable and reproducible trajectory of. Diagnosis management chronic compartment syndromes. Cecs is extremely rare in the forearm and, as illustrated by the case described here, can present a difficult diagnostic problem. An unrecognized cause of exertional compartment syndrome. The condition could be categorized as acute or chronic. The pain associated with this condition is thought to be abnormal pressure. Chronic compartment syndrome definition of chronic. The utility of ultrasound in detecting anterior compartment thickness changes in chronic exertional compartment syndrome. Chronic compartment syndrome can first be treated by avoiding the activity that caused it and with stretching and physical therapy exercises. Get a printable copy pdf file of the complete article 1. Chronic exertional compartment syndrome of the forearm in elite rowers. Aug 12, 2014 acute and chronic compartment syndrome occurs when there is increased tissue pressure within a tight fascial compartment, impairing nervous tissue andor vascular supply and tissue perfusion. Begin by rolling slowly from the affected limb toward the body. Chronic exertional compartment syndrome of the forearms.
Continue with an ice massage to reduce swelling and pain. This syndrome is a condition that can appear in many parts of the body. A compartment syndrome is defined as a condition in which increased pressure within a limited space compromises the circulation and function of tissues within. Ultrasoundguided fasciotomy for anterior chronic exertional. In patients who have failed conservative measures, fasciotomy is the treatment of choice. Acute compartment syndrome and severe cases chronic of compartment syndrome will typically require surgery, followed by physical therapy. Chronic compartment syndrome most often occurs in athletes aged under 40 years but can occur at any age. The consequences of compartment syndrome are reduction in capillary blood perfusion for tissue viability and compromise of neuromuscular function as a result of high pressure within a closed fascial space. Rehabilitation guidelines following compartment syndrome. Chronic exertional compartment syndrome exercise, especially when it involves repetitive motion, can cause this form of compartment syndrome.
Additionally, there is an increase of pressure in skeletal muscle accompanied by pain. Chronic compartment syndrome stress test serial compartment pressure resting 15mm hg 5 min postex. A chronic exertional compartment syndrome has only been observed in athletes and soldiers. The chronic venous compartment syndrome request pdf. The pain associated with this condition is thought to be abnormal pressure in the. Chronic compartment syndrome, an important cause of workrelated upper limb disorder m. Diagnosis and management of chronic compartment syndromes. Chronic exertional compartment syndrome symptoms and. Cs usually presents acutely, most commonly as a result of fractures, muscle rupture or intracompartmental vascular injury, and generally requires immediate surgical treatment.
Chronic exertional compartment syndrome of the deep posterior. Fasciotomy for chronic exertional compartment syndrome day of surgery a. The increase in interstitial pressure occurs within the osseofascial compartment. Chronic exertional compartment syndrome diagnosis and. Ccs may be considered an uncommon though important cause of exerciseinduced leg andor foot pain. It clinically manifests by recurrent episodes of muscle cramping, tightness, and occasional paresthesias. Conservative treatment includes rest, antiinflammatory medications, and manual decompression. Chronic compartment syndrome ccs is an exerciseinduced condition characterized by recurrent pain and disability. Jun 27, 2014 acute compartment syndrome acs is a surgical emergency warranting prompt evaluation and treatment. Chronic exertional compartment syndrome is an exerciseinduced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms.
Read about causes, treatment, surgery, and see pictures. Chronic exertional compartment syndrome affects young athletic individuals, especially those in active duty military service. Outcome of a specific compartment fasciotomy versus a complete compartment fasciotomy of the leg in one patient with bilateral anterior chronic exertional compartment syndrome. Resultant ischaemic damage may be irreversible within six hours and can result in longterm morbidity and even death. Limit your physical activities to those that dont cause pain, especially focusing on lowimpact activities such as cycling or an elliptical trainer. Chronic exertional compartment syndromes cecs are much less common and usually occur in the lower limb compartments. Rydholm et al corr 1983 volumetrics nerve conduction velocities. Implications for clinical diagnostic criteria and therapy. August, 2005 acute compartment syndrome of the limb. Confirm suspicion of chronic compartment syndrome by documenting intracompartmental pressures. Chronic compartment syndrome, an important cause of work.
To help relieve the pain of chronic exertional compartment syndrome, try the following. Acute compartment syndrome acs is a surgical emergency warranting prompt evaluation. Workrelated upper limb disorder wruld is a general and nonspecific label referring to a range of musculoskeletal conditions affecting the upper limb, caused or made worse by work. Symptoms subside when the offending activity usually running is stopped but return when the activity is resumed.
Chronic exertional compartment syndrome disease reference. S ir, compartment syndrome cs occurs when the interstitial pressure in a closed fascial compartment increases to such a degree that local blood flow is compromised, resulting in tissue ischaemia. Chronic exertional compartment syndrome cecs is an underdiagnosed cause of chronic exertional leg pain. Chronic exertional compartment syndrome of the leg in the military. Other diagnostic modalities, though promising, have no place in the work up currently c. Pritchard, department of rheumatology, university hospital of wales, cardiff cf14 4xw, uk. Chronic exertional compartment syndrome cecs is a painful condition of the lower leg that affects many runners and other athletes involved in repetitive impact activities. Compartment syndrome is a painful condition that occurs when too much pressure is built up within and between muscles. About compartment syndrome, compartment syndrome clinic uw. A surgical procedure called fasciotomy is the most effective treatment of chronic exertional compartment syndrome. Chronic exertional compartment syndrome of the leg alicia k. Modified criteria for the objective diagnosis of chronic.
Pdf chronic exertional compartment syndrome cecs is an underdiagnosed condition that causes lower and upper extremity pain in certain. For example, if running bothers your legs, try swimming. The syndrome most commonly occurs in young adult recreational runners, elite athletes, and military recruits. It involves cutting open the inflexible tissue encasing each of the affected muscle compartments fascia. Chronic exertional compartment syndrome cecs is a significant source of lower extremity pain and morbidity in the athletic population. Prevalence of chronic compartment syndrome of the legs. A condition in which increased compartment pressure within a confined space, compromises the circulation and viability. About compartment syndrome, compartment syndrome clinic. Chronic exertional compartment syndrome that is refractory to conservative management, such as resting, physical therapy, gait retraining, and forefoot running, 9,10 should be treated with. In the presence of appropriate clinical findings, we consider one or more of the following intramuscular pressure criteria to be diagnostic of chronic compartment syndrome of the leg. Chronic exertional compartment syndrome of the forearm in. Pdf on feb 1, 1991, f lokiec and others published chronic compartment syndrome of both feet find, read and cite all the research you need on. Acute compartment syndrome is usually caused by a severe injury, such as a car accident or a broken bone. Elevation of the affected limb in patients with compartment syndrome is contraindicated, as this leads to decreased vascular perfusion of the affected region.
Compartment syndrome ace physical therapy and sports. Pdf chronic compartment syndrome of both feet researchgate. Chronic exertional compartment syndrome of the forearm. Interstitial fluid pressure in muscle and compartment syndromes in man. Compartment syndrome can occur in the legs, feet, arms or hands. However,overthepast40 years there have been well over documentedcases mostly confirmedbyintracompartmental pressure measurement and the successful outcomeoffasciotomy, soit would seem that griffiths was wrong, and chronic compartment syndrome is nowa well recog. Sometimes, a fasciotomy can be performed through small incisions and this may reduce recovery. Chronic exertional compartment syndrome cecs is an overuse injury characterized by increased intracompartmental pressure during exercise. Chronic compartment syndrome in the forearm can occur in gymnasts and climbers,27 and musicians41 in a study in italy the highest incidence of chronic compartment syndrome in the forearm was found in professional motorcycle drivers41 runners and aerobic trainers can getchronic compartment syndrome in the foot27. It can damage muscles and nerves and lead to decreased blood flow. Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency.
Exerciseinduced chronic compartment syndrome of the first dorsal. Jhs 1988 chronic compartment syndrome treatment modification of activity splinting elective fasciotomy. Cecs has been described in the foot, thigh, and trunk. A condition that typically arises in the anterior compartment of the lower leg, characterised by cramping, pain and tightness, often with numbness and tingling in the foot. Compartmental syndrome is defined as a critical pressure increase within a confined compartmental space causing a decline in the perfusion pressure to the tissue within that compartment. For chronic compartment syndrome, release the pressure of residual swelling by using a massage stick or foam roller to roll along the muscles. Acute compartment syndrome acs is a surgical emergency warranting prompt evaluation and treatment. Thick bands of tissue called fascia divide groups of muscles in the arms and legs. In the vast majority, the disease affects the anterior compartment and the fibular muscle group, and only. A condition in which increased compartment pressure within a confined space, compromises the circulation and viability of the tissues within that. Selective fasciotomy for chronic exertional compartment. Compartment syndrome is a fairly common condition noted in patients with fractures or crush injuries to the extremities acute compartment syndrome and in. Management of chronic exertional compartment syndrome article pdf available in south african journal of surgery.
Chronic exertional compartment syndrome of the leg. Jul 26, 2017 compartment syndrome can be acute or chronic. Reducing the swelling and pressure of the muscles will alleviate pain. Chronic exertional compartment syndrome symptoms and causes. Compartment syndrome can be either acute or chronic. Pdf prevalence of chronic compartment syndrome of the legs. However, mild cases of chronic compartment syndrome can be treated conservatively with physical therapy, so its important to.
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