chronic exertional compartment syndrome (CECS)

Epidemiology

• most commonly occurs in young athletes, especially runners

Pathology

• exertion-provoked swelling of a specific muscle bed within a compartment of an extremity
• the anterior compartment of the lower leg is the most common site

Clinical manifestations

• case report
  • throbbing bilateral anterior shin pain during exercise
  • resolves completely within 10 minutes
  • physical exam normal
• throbbing pain, paresthesias, & sometimes weakness & foot drop during exercise, with complete resolution after rest

Laboratory

• serum creatine kinase normal (case report)

Diagnostic procedures

• lower extremity compartment pressure measurement at rest & with exertion

Radiology

• Radiographs & MRI of bilateral tibias & fibulae are normal (case report)

Differential diagnosis

• peripheral arterial disease (PAD)
  • exercise cause pain earlier in PAD than CECS (median 4 vs 15 minutes)=
  • cessation of exercise alleviates pain almost immediately in all PAD patients
  • low-grade pain lingers at rest in most patients with CECS
  • symptoms bilateral in 1/2 of both PAD & CECS patients
  • CECS patients more likely to describe tightness, muscle weakness, & altered sensation during exercise
• shin splints

Management

• modification of the exercise regimen & training surfaces
• shoe inserts
• gait retraining
• if conservative measures are ineffective, surgical fasciotomy may be required

More general terms

• compartment syndrome