eMedicine Specialties > Sports Medicine > Introductory Topics in Sports Medicine

Compartment Syndromes: Follow-up

Author: Gregory A Rowdon, MD, Associate Clinical Professor, Department of Medicine, Division of Family Practice, Indiana University Medical Center; Team Physician, Purdue University
Coauthor(s): Basim Abdelkarim, MD, Staff Physician, Department of Internal Medicine, University of California at Irvine Medical Center; Federico E Vaca, MD, FACEP, Team Physician, Department of Emergency Medicine, University of California Irvine; Clinical Assistant Professor, University of California at Irvine School of Medicine
Contributor Information and Disclosures

Updated: Oct 29, 2008

Follow-up

Return to Play

For the athlete with chronic exertional compartment syndrome (CECS), return to play may not be a viable option without surgical intervention. Consultation with a primary care sports medicine specialist and/or sports medicine orthopedic specialist is usually needed.

After surgical intervention to release the involved compartment, range-of-motion activity often begins immediately.

Weight bearing begins within the first week by means of aided or unaided walking. Activity can be upgraded to stationary cycling or swimming after the wounds heal. Isokinetic muscle strengthening exercises can begin at 3-4 weeks. Running is integrated into the activity program at 5-6 weeks. Full activity is introduced at approximately 6-12 weeks, with a focus on speed and agility.

Complications

Surgical intervention generally has good success in persons with chronic exertional compartment syndrome (CECS), with success defined as the return to athletics without significant symptoms. In the anterior compartment of the leg, success rates usually exceed 85%. In the deep posterior compartment, success rates are approximately 70%.

For unknown reasons, the deep posterior compartment does not respond as quickly or as well to fasciotomy as the anterior compartment. The majority of complications can be attributed to surgical intervention or misdiagnosis. Other reasons include postoperative hemorrhage, postoperative infection, recurrent compartment syndrome, Volkmann contracture, and permanent disability.

Prevention

Limited information is available on true prevention of chronic exertional compartment syndrome (CECS). Cross-training exercises should be encouraged (eg, swimming, bicycling, other low-impact activities) and muscle stretching before initiating exercise.

Prognosis

The postsurgical prognosis is good if the initial diagnosis of chronic exertional compartment syndrome (CECS) is correct.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the correct initial diagnosis: Making the correct initial diagnosis is key to the successful management and treatment of chronic exertional compartment syndrome (CECS). Misdiagnosis can lead to complications resulting from unnecessary surgery.

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Medical Malpractice and Legal Issues

Special Concerns

  • Consider the significant overlap between chronic exertional compartment syndrome (CECS) and other lower extremity pain syndromes and entities. These may include periostitis, tibial stress fracture, and anterior tibial pain syndrome (ie, medial tibial stress syndrome, lateral tibial stress syndrome).
 


More on Compartment Syndromes

Overview: Compartment Syndromes
Differential Diagnoses & Workup: Compartment Syndromes
Treatment & Medication: Compartment Syndromes
Follow-up: Compartment Syndromes
References
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References

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Further Reading

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Keywords

chronic exertional compartment syndrome, compartment syndromes, compartment syndrome, CECS, anterior compartment syndrome, exercise-induced lower leg pain, increased intracompartmental pressure, nerve compression syndromes, ischemic contracture, anterior tibial syndrome

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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)

Basim Abdelkarim, MD, Staff Physician, Department of Internal Medicine, University of California at Irvine Medical Center
Basim Abdelkarim, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Federico E Vaca, MD, FACEP, Team Physician, Department of Emergency Medicine, University of California Irvine; Clinical Assistant Professor, University of California at Irvine School of Medicine
Federico E Vaca, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Association for the Advancement of Automotive Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD 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, North American Primary Care Research Group, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
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, Sports Medicine Fellowship Director, 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, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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