Chronic Exertional Compartment Syndrome Clinical Presentation

  • Author: Gregory A Rowdon, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Aug 8, 2011
 

History

Chronic exertional compartment syndrome (CECS) is usually observed in competitive or collegiate athletes. Patients report pain or tightness, cramping, burning, or aching over the affected compartment during exercise. The affected extremity may feel weak.

The anterior and lateral compartments of the lower leg are commonly affected; the deep and posterior compartments are less commonly involved. Case studies of CECS in the forearm, thigh,[18] and gluteal regions have been published, but they are rare. CECS is often bilateral, although involvement of a single extremity may occur.

Like claudication, the pain may develop predictably at a specific point in an exercise session (ie, distance, time interval, level of intensity). For example, most long-distance runners reproducibly experience the onset of pain within 15 minutes of initiating their run. Athletes may not be able to play through the severe pain. However, runners may be able to continue running with a modified flatfoot strike.

A sense of fullness in the compartment typically has a gradual onset, which usually worsens as activity progresses. Pain may be increased with active contraction and passive stretching during symptomatic episodes. Commonly, the patient notes the sensation of weakness, which is usually described as a loss of control of the affected extremity. For example, a runner may develop foot slap on heel-strike due to weakness of the tibialis anterior muscle. Paresthesia or dysesthesia may develop in the distribution of the affected nerve.

Symptoms tend to subside with rest. Any persistent symptoms are usually minimal during normal daily activities.

The patient may note bumps or herniations over the affected compartment. The patient usually denies any edema, temperature changes, or color changes of the affected extremity.

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Physical Examination

Physical examination findings in patients with CECS are usually normal, unless the patient has a history of recent exercise. The musculature in the affected compartment may feel firm or tense to palpation.

If the anterior compartment is affected, the patient may exhibit weakness on dorsiflexion and loss of sensation in the web of the first toe due to involvement of the deep peroneal nerve.[19] In addition, evidence of muscle hernias is present in 20-60% of patients with anterior CECS.

If the lateral compartment is affected, the patient may exhibit weakness upon inversion, with loss of sensation on the anterolateral part of the shin and the dorsum of the foot due to involvement of the superficial peroneal nerve.

If the deep posterior compartment is affected, the patient may exhibit weakness in the foot muscles and loss of sensation in the foot arch due to involvement of the tibial nerve.

The patient should have normal distal pulses. If the pulses are decreased, an arterial source should be considered, and evaluation for arterial insufficiency including popliteal artery entrapment should be undertaken.

The neurologic examination results should be normal. If not, then a primary neurologic process should be considered.

Patients with CECS usually do not have tenderness over the posterior medial tibial cortex in the distal leg. This contrasts with medial tibial stress syndrome, in which tenderness is typically located in this area.

Patients with CECS usually do not present with focal tenderness with overlying edema. This finding is more indicative of a stress fracture.

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Contributor Information and Disclosures
Author

Gregory A Rowdon, MD  Associate Clinical Professor, Department of Medicine, Division of Family Practice, Indiana University Medical Center; Team Physician, Purdue University

Gregory A Rowdon, MD is a member of the following medical societies: American College of Sports Medicine and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Samuel Agnew, MD, FACS  Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE  Robert L and Mary Ellenburg Professor of Surgery, Professor, Department of Orthopedic Surgery, Fellowship Director, Orthopedic Adult Reconstruction, Affiliated Faculty, Department of Bioengineering, Affiliated Faculty, Stanford Center on Longevity, Stanford University School of Medicine, Stanford University Medical Center

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, California Medical Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

Steven I Rabin, MD  Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Douglas G Smith, MD  Associate Professor, Department of Orthopedic Surgery, Harborview Medical Center, University of Washington School of Medicine

Disclosure: Nothing to disclose.

Jeffrey L Visotsky, MD  Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Stephen Wallace, MD  Staff Physician, Department of Emergency Medicine, Memorial Hospital of Sweetwater County

Stephen Wallace, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family and Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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An illustration that depicts measurement of compartment pressures in the forearm.
 
 
 
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