Chronic Exertional Compartment Syndrome Medication
- Author: Gregory A Rowdon, MD; Chief Editor: Craig C Young, MD more...
Analgesics may be warranted in patients with chronic exertional compartment syndrome (CECS), but they play a minimal role in the treatment of this condition. Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain management.
Adverse effects and patient profiles should be considered when choosing medications. Acetaminophen can result in liver damage. NSAIDs can result in gastrointestinal upset, gastrointestinal bleeding, renal damage, and impaired coagulation.
Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained trauma or injuries.
Acetaminophen is the drug of choice for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.
Nonsteroidal Anti-Inflammatory Drugs
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action may include inhibition of cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Naproxen is indicated for relief of mild to moderate pain. This agent inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Ketorolac is an intravenously administered NSAID and a very powerful analgesic. It inhibits prostaglandin synthesis by decreasing activity of the enzyme cyclooxygenase, which results in decreased formation of prostaglandin precursors. In turn, this results in reduced inflammation.
Aspirin treats mild to moderate pain. It inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.
Ibuprofen is usually the drug of choice for treatment of mild to moderate pain, if no contraindications exist. It inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclo-oxygenase, resulting in inhibition of prostaglandin synthesis.
Unlike nonselective NSAIDs, which inhibit both cyclooxygenase-1 (COX-1) and COX-2, celecoxib primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme that is induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations celecoxib does not inhibit COX-1; thus GI toxicity may be decreased.
Although the higher cost of celecoxib can be a drawback, the incidence of costly and potentially fatal GI bleeds is clearly less with this agent than it is with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-2 inhibitors the most beneficial. Seek the lowest dose of celecoxib for each patient.
Claes T, Van der Beek D, Claes S, Verfaillie S, Bataillie F. Chronic exertional compartment syndrome of the forearm in motocross racers. Presented at: The European Sports Medicine Congress; Hasselt, Belgium; May 14-16, 2003.
Piasecki DP, Meyer D, Bach BR Jr. Exertional compartment syndrome of the forearm in an elite flatwater sprint kayaker. Am J Sports Med. 2008 Nov. 36(11):2222-5. [Medline].
Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. 2000 Mar. 32(3 suppl):S4-10. [Medline].
Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975 Nov-Dec. 43-51. [Medline].
Whitesides TE Jr, Haney TC, Harada H, Holmes HE, Morimoto K. A simple method for tissue pressure determination. Arch Surg. 1975 Nov. 110(11):1311-3. [Medline].
Roberts A, Franklyn-Miller A. The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports. 2012 Oct. 22 (5):585-95. [Medline].
Tiidus PM. Is intramuscular pressure a valid diagnostic criterion for chronic exertional compartment syndrome?. Clin J Sport Med. 2014 Jan. 24 (1):87-8. [Medline].
Roscoe D, Roberts AJ, Hulse D. Intramuscular compartment pressure measurement in chronic exertional compartment syndrome: new and improved diagnostic criteria. Am J Sports Med. 2015 Feb. 43 (2):392-8. [Medline].
Wittstein J, Moorman CT 3rd, Levin LS. Endoscopic compartment release for chronic exertional compartment syndrome. J Surg Orthop Adv. 2008 Summer. 17(2):119-21. [Medline].
Reneman RS. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles. Clin Orthop Relat Res. 1975 Nov-Dec. 69-80. [Medline].
Clayton JM, Hayes AC, Barnes RW. Tissue pressure and perfusion in the compartment syndrome. J Surg Res. 1977 Apr. 22(4):333-9. [Medline].
Shrier I, Magder S. Pressure-flow relationships in in vitro model of compartment syndrome. J Appl Physiol. 1995 Jul. 79(1):214-21. [Medline].
Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. 2006 Nov. 49(11):1772-80. [Medline].
Wassenaar EB, van den Brand JG, van der Werken C. Compartment syndrome of the lower leg after surgery in the modified lithotomy position: report of seven cases. Dis Colon Rectum. 2006 Sep. 49(9):1449-53. [Medline].
Rafiq I, Anderson DJ. Acute rhabdomyolysis following acute compartment syndrome of upper arm. J Coll Physicians Surg Pak. 2006 Nov. 16(11):734-5. [Medline].
Walker JL, Smith GH, Gaston MS, Robinson CM. Spontaneous compartment syndrome in association with simvastatin-induced myositis. Emerg Med J. 2008 May. 25(5):305-6. [Medline].
Amendola A, Rorabeck CH, Vellett D, et al. The use of magnetic resonance imaging in exertional compartment syndromes. Am J Sports Med. 1990 Jan-Feb. 18(1):29-34. [Medline].
Kaper BP, Carr CF, Shirreffs TG. Compartment syndrome after arthroscopic surgery of knee. A report of two cases managed nonoperatively. Am J Sports Med. 1997 Jan-Feb. 25(1):123-5. [Medline].
Awbrey BJ. Office diagnosis and intraoperative pressure-assisted fasciotomy for exercise-induced compartment syndrome. Paper (no. 395) presented at: Annual Meeting of the American Academy of Orthopaedic Surgeons; March 19-22, 1998; New Orleans, La.
King TW, Lerman OZ, Carter JJ, Warren SM. Exertional compartment syndrome of the thigh: a rare diagnosis and literature review. J Emerg Med. 2010 Aug. 39(2):e93-9. [Medline].
Rowdon GA, Richardson JK, Hoffmann P, Zaffer M, Barill E. Chronic anterior compartment syndrome and deep peroneal nerve function. Clin J Sport Med. 2001 Oct. 11(4):229-33. [Medline].
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 Jan-Feb. 18(1):35-40. [Medline].
Edwards PH Jr, Wright ML, Hartman JF. A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med. 2005 Aug. 33(8):1241-9. [Medline].
Black KP, Taylor DE. Current concepts in the treatment of common compartment syndromes in athletes. Sports Med. 1993 Jun. 15(6):408-18. [Medline].
Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. 1985 May-Jun. 13(3):162-70. [Medline].
Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg. Long-term followup. Am J Sports Med. 1993 Nov-Dec. 21(6):811-7; discussion 817. [Medline].
Mouhsine E, Garofalo R, Moretti B, Gremion G, Akiki A. Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. 2006 Feb. 14(2):193-7. [Medline].
Raikin SM, Rapuri VR, Vitanzo P. Bilateral simultaneous fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int. 2005 Dec. 26(12):1007-11. [Medline].
Rorabeck CH, Fowler PJ, Nott L. The results of fasciotomy in the management of chronic exertional compartment syndrome. Am J Sports Med. 1988 May-Jun. 16(3):224-7. [Medline].
Fronek J, Mubarak SJ, Hargens AR, ET AL. Management of chronic exertional anterior compartment syndrome of the lower extremity. Clin Orthop Relat Res. 1987 Jul. 220:217-27. [Medline].
Sebik A, Dogan A. A technique for arthroscopic fasciotomy for the chronic exertional tibialis anterior compartment syndrome. Knee Surg Sports Traumatol Arthrosc. 2008 May. 16(5):531-4. [Medline].
Schepsis AA, Gill SS, Foster TA. Fasciotomy for exertional anterior compartment syndrome: is lateral compartment release necessary?. Am J Sports Med. 1999 Jul-Aug. 27(4):430-5. [Medline].
Hutchinson MR, Ireland ML. Common compartment syndromes in athletes. Treatment and rehabilitation. Sports Med. 1994 Mar. 17(3):200-8. [Medline].
Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. 2009 Jan. 102(1):3-11. [Medline].