eMedicine Specialties > Sports Medicine > Introductory Topics in Sports Medicine

Compartment Syndromes: Treatment & Medication

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

Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

Conservative therapy has been attempted  for chronic exertional compartment syndrome (CECS), but it is generally unsuccessful once the patient returns to normal activity.6 Massage therapy and physical therapy have been reported to be successful, but these reports remain largely anecdotal with regard to successful treatment. Discontinuance of sports participation is an option, but it is usually a choice most athletes refuse.

Medical Issues/Complications

One must perform a full evaluation and assessment to appropriately diagnose chronic exertional compartment syndrome (CECS). An error in diagnosis can lead to unnecessary surgical procedures (eg, fasciotomy, fasciectomy), which may lead to further complications.

Surgical Intervention

Once a patient has been diagnosed with chronic exertional compartment syndrome (CECS), surgical intervention is usually initiated. Fasciotomy may be performed once consultation with a surgeon has been obtained.7,8,9,10 Fasciotomy of the anterior compartment has a better outcome than fasciotomy of the posterior compartment.11,12,13,14,15

Furthermore, the rehabilitation phase is prolonged for patients who undergo deep posterior compartment fasciotomy compared with those who undergo anterior compartment fasciotomy. The reasons for this difference in outcome remain unclear. Acute compartment syndrome requires fasciotomy immediately upon diagnosis.

Multiple techniques have been described for fasciotomy of the lower leg. Newer techniques have been developed to minimize the skin incision and maximize the fascial release.

Recurrence after fasciotomy is unusual. If fasciotomy fails, the diagnosis of chronic exertional compartment syndrome (CECS) should be fully reevaluated. Repeat pressure measurements are usually required. For a true recurrence, a second decompression is performed via fasciectomy and is usually successful. 

Wittstein et al have suggested that "endoscopic assistance may minimize the intraoperative and postoperative complications associated with compartment release and offer improved cosmesis."6 The investigators used a balloon dissector that was designed to address the shortcomings of open and semi-blind techniques.

Consultations

Orthopedic, vascular surgery, and radiologic (imaging specialists) consultations should be sought in cases of chronic exertional compartment syndrome (CECS).

Recovery Phase

Rehabilitation Program

Physical Therapy

Physical therapy for chronic exertional compartment syndrome (CECS) includes rest, muscle stretching before exercise, shoe modification, and nonsteroidal anti-inflammatory medications (NSAIDs) to reduce inflammation. Do not cast, splint, or compress the affected limb.

Recreational Therapy

Presurgical therapy chronic exertional compartment syndrome (CECS) includes reduction of activity, with encouragement of cross-training exercises (eg, swimming, bicycling, other low-impact activities).

Surgical Intervention

Consider fasciotomy if symptoms of chronic exertional compartment syndrome (CECS) persist and compartment pressures are elevated.

Consultations

Surgical consultations for chronic exertional compartment syndrome (CECS) should include orthopedic and vascular surgeons.

Maintenance Phase

Rehabilitation Program

Physical Therapy

Postsurgical therapy for chronic exertional compartment syndrome (CECS) includes assisted weight bearing with some variation, depending on surgical technique. Some physicians recommend immediate postsurgical range-of-motion activity that may include walking (unaided by 3-5 d). Early mobilization as soon as is feasible is recommended by many surgeons to avoid or prevent scarring leading to adhesions and a recurrence of the syndrome. 

Recreational Therapy

Postsurgical therapy includes cycling and swimming after healing of the surgical wounds (weeks later). Running can be performed at 3-6 weeks and full activity within approximately 6-12 weeks.

Medical Issues/Complications

The surgical result in a true case of chronic exertional compartment syndrome (CECS) is usually good, with significant improvement of exertional pain.

  • Pain can recur, and, if so, consider the possibility of an error in the initial diagnosis.
  • Additionally, if pain persists with activity, consider the possibility of incomplete or incorrect decompression of a muscle compartment. 
  • Complication rates of surgery have been reported in the 11-13% range and include hemorrhage, wound breakdown, pain recurrence, and complications from anesthesia.

Surgical Intervention

In the case of recurrent exertional pain, a repeat fasciotomy/fasciectomy may be needed.

Consultations

Consult an orthopedic surgeon if or when complications arise in cases of chronic exertional compartment syndrome (CECS).

Medication

Analgesics may be warranted in patients with chronic exertional compartment syndrome (CECS) , but they play a minimal role in the treatment of this condition.  

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

  1. Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. Mar 2000;32(3 suppl):S4-10. [Medline].

  2. Amendola A, Rorabeck CH, Vellett D, et al. The use of magnetic resonance imaging in exertional compartment syndromes. Am J Sports Med. Jan-Feb 1990;18(1):29-34. [Medline].

  3. Rowdon GA, Richardson JK, Hoffmann P, Zaffer M, Barill E. Chronic anterior compartment syndrome and deep peroneal nerve function. Clin J Sport Med. Oct 2001;11(4):229-33. [Medline].

  4. Hayes AA, Bower GD, Pitstock KL. Chronic (exertional) compartment syndrome of the legs diagnosed with thallous chloride scintigraphy. J Nucl Med. Sep 1995;36(9):1618-24. [Medline]. [Full Text].

  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. Jan-Feb 1990;18(1):35-40. [Medline].

  6. Wittstein J, Moorman CT 3rd, Levin LS. Endoscopic compartment release for chronic exertional compartment syndrome. J Surg Orthop Adv. Summer 2008;17(2):119-21. [Medline].

  7. 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. Aug 2005;33(8):1241-9. [Medline].

  8. Black KP, Taylor DE. Current concepts in the treatment of common compartment syndromes in athletes. Sports Med. Jun 1993;15(6):408-18. [Medline].

  9. Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. May-Jun 1985;13(3):162-70. [Medline].

  10. Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg. Long-term followup. Am J Sports Med. Nov-Dec 1993;21(6):811-7; discussion 817. [Medline].

  11. 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. Feb 2006;14(2):193-7. [Medline].

  12. Raikin SM, Rapuri VR, Vitanzo P. Bilateral simultaneous fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int. Dec 2005;26(12):1007-11. [Medline].

  13. Styf JR, Körner LM. Chronic anterior-compartment syndrome of the leg. Results of treatment by fasciotomy. J Bone Joint Surg Am. Dec 1986;68(9):1338-47. [Medline]. [Full Text].

  14. Rorabeck CH, Fowler PJ, Nott L. The results of fasciotomy in the management of chronic exertional compartment syndrome. Am J Sports Med. May-Jun 1988;16(3):224-7. [Medline].

  15. Fronek J, Mubarak SJ, Hargens AR, ET AL. Management of chronic exertional anterior compartment syndrome of the lower extremity. Clin Orthop Relat Res. Jul 1987;220:217-27. [Medline].

  16. Abramowitz AJ, Schepsis AA. Chronic exertional compartment syndrome of the lower leg. Orthop Rev. Mar 1994;23(3):219-25. [Medline].

  17. Edmundsson D, Svensson O, Toolanen G. Intermittent claudication in diabetes mellitus due to chronic exertional compartment syndrome of the leg: an observational study of 17 patients. Acta Orthop. Aug 2008;79(4):534-9. [Medline]. [Full Text].

  18. Jowett A, Birks C, Blackney M. Chronic exertional compartment syndrome in the medial compartment of the foot. Foot Ankle Int. Aug 2008;29(8):838-41. [Medline].

  19. Rorabeck CH. Exertional tibialis posterior compartment syndrome. Clin Orthop Relat Res. Jul 1986;208:61-4. [Medline].

  20. Tzortziou V, Maffulli N, Padhiar N. Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom. Clin J Sport Med. May 2006;16(3):209-13. [Medline].

  21. Veith RG, Matsen FA 3rd, Newell SG. Recurrent anterior compartmental syndromes. Phys Sportsmed. 1980;8(11):80-8.

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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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