Chronic Exertional Compartment Syndrome Clinical Presentation

Updated: Oct 08, 2015
  • Author: Gregory A Rowdon, MD; Chief Editor: Craig C Young, MD  more...
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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, [21] 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.


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. [22] 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.