Working Diagnosis:
Chronic Exertional Compartment Syndrome

Treatment:
The patient was referred to orthopedic surgery for compartment pressure testing. The compartment pressures of the anterior and lateral leg compartments demonstrated resting pressures of 12 mmHg and 24 mmHg, respectively. The lateral leg compartment pressure was elevated per the Pedowitz criteria. But, post-exercise compartment pressures were not obtained.

Outcome:
The patient was advised to refrain from symptom-worsening exercises, but otherwise had no activity restrictions. She continued to follow-up with orthopedics to consider fasciotomy for symptomatic relief.

Author's Comments:
Chronic exertional compartment syndrome (CECS) is an often under-diagnosed syndrome related to repetitive motion activities.
While acute compartment syndrome is often attributed to trauma, CECS is often due to overuse. Most often, the lower extremities are involved, usually in running athletes. Of these athletes, 33% sustain injuries to their lateral leg compartments. Though fasciotomy is considered definitive treatment for symptom relief of CECS, many athletes improve with physical therapy and activity modification. Athlete education may allow for earlier evaluation and diagnosis.
If addressed at early stages, patients may be able to circumvent advancement of disease, prolong high-intensity athletic endeavors, avoid discomfort, and improve quality of life and athletic performance.

Editor's Comments:
Chronic exertional compartment syndrome can often be a presumptive diagnosis based on history and physical exam. If symptoms are more severe and invasive treatment, such as fasciotomy, is considered, then definitive diagnosis of CECS must be made with compartment pressure testing. The most common criteria used for lower extremity CECS is the Pedowitz criteria. Further research has been ongoing to consider noninvasive diagnostic testing. Alternative diagnoses, such as popliteal artery entrapment, should be considered prior to fasciotomy especially given its common co-presentation with CECS.

References:
1. Gill CS, Halstead ME, Matava MJ. Chronic exertional compartment syndrome of the leg in athletes: evaluation and management. Phys Sportsmed. 2010;38(2):126-132.

2. Buerba RA, Fretes NF, Devana SK, Beck JJ. Chronic exertional compartment syndrome: current management strategies. Open Access J Sports Med. 2019;10:71-79.

3. van Zantvoort AP, de Bruijn JA, Winkes MB, et al. Isolated Chronic Exertional Compartment Syndrome of the Lateral Lower Leg: A Case Series. Orthop J Sports Med. 2015;3(11):2325967115617728.

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