Topics in Sports Medicine
Chronic Exertional Compartment Syndrome in a Healthy Young Man

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Abstract

Objective

The purpose of this case report is to describe a patient who presented with symptoms of exercise-induced compartment syndrome and was later referred for bilateral fasciotomy surgery.

Clinical Features

A 21-year-old patient presented for chiropractic care with the inability to run due to foot paresthesia and weakness. An exertion test and compartment pressure test diagnosed exercise-induced compartment syndrome. Exertion test and compartment pressure test were used to identify and diagnose exercise-induced compartment syndrome.

Intervention and Outcome

The patient was diagnosed with exercise-induced compartment syndrome. He was treated conservatively and referred for additional testing. The orthopedic surgeon requested that 12 weeks of conservative care be provided prior to testing; treatment consisted of chiropractic care and rehabilitation exercises. Following the 12 weeks of treatment, the patient did not significantly respond to conservative care. A compartment pressure test confirmed the initial diagnosis of exercise-induced compartment syndrome. The patient underwent a unilateral fasciotomy surgery and recovered fully. Following the surgery, the patient returned to the chiropractic clinic with the same presentation in the contralateral leg. The same protocol of management resulted in the same outcome. Two years after surgical intervention, the patient continues to maintain an active lifestyle, able to run 2 to 3 miles per day without any exacerbations or symptomatology.

Conclusion

Clinical awareness, a detailed history, and thorough examination with reproduction of symptomatology are necessary to form a proper diagnosis and treatment plan for these patients. Therefore, multidisciplinary medical communication would prove to be the most beneficial approach for the patient.

Introduction

Exercise-induced compartment syndrome of the lower extremity affects athletes who increase activity levels in both intensity and duration. One theory explains the reasons for the condition such as vascular compromise and ischemia due to the muscular pressure raises from increased exercise demands.1, 2, 3, 4, 5, 6, 7

Chronic exertional compartment syndrome (CECS) is a reversible ischemic state that is secondary to a noncompliant osseofascial compartment. During exercise, there is an elevated demand from the muscle for oxygen with increasing the blood flow to the muscle. This causes the muscle to swell. In compartment syndrome, a fascial restriction by the sheaths of the connective tissue surrounding the various levels muscle fibers limits muscle expansion and decreases blood flow to the region as well. The muscle then reacts to the oxygen deprivation with the signs and symptoms of muscle cramping, pain, and/or weakness, which may lead to severe disability in the affected extremity.2, 8, 9, 10, 11, 12, 13, 14, 15

It is currently hypothesized that, in CECS, exercise increases intramuscular pressure, resulting in symptoms. Chronic exertional compartment syndrome is more prominent in athletes who participate in sports or activities that involve repetitive impact such as running or fast walking.

Overuse injuries are the result of repetitive microtrauma, leading to damage that occurs to the intra- and intercellular tissue. The changes that occur from the microtrauma damage can range from the formation of scar tissue to tissue degeneration. These changes have been observed in athletes following an increase in training intensity and/or duration. Therefore, CECS and other overuse injuries typically occur when performance training increases at a rate faster than the body can adapt. Some of the conditions to consider for differential diagnosis of CECS include intermittent claudication, lumbar disk herniation, stress fracture, medial tibial stress syndrome, muscle strain, and tibiofibular joint dysfunction.2, 4, 8, 12, 16, 17, 18, 19, 20, 21, 22

The purpose of this case report is to describe the presentation and management of CECS in a 21-year-old man.

Section snippets

Case Report

A healthy 21-year-old man initially presented to a chiropractic office with a chief concern of pain in the sole of the left foot. The pain was intermittent, nontraumatic gradual unset for the previous 2 months. The pain was worse after rest, especially first thing in the morning. The patient stated that, previously, he was in a marching band which practices for multiple hours per day and, currently, he was training aerobically in preparation for entrance into the Air Force boot camp. For the

Discussion

An otherwise healthy 21-year-old man who presented with a chief concern of pain in the sole of the left foot would have been a regular patient at any physician’s office. The change in symptomatology and results from the functional examination were the key components that led to the diagnosis of CECS. The patient had increased training intensity and duration, which are some of the factors previously seen in patients with these types of concerns and presentation.

Exercise-induced compartment

Limitations

This is a single retrospective case presentation intended to describe the case presentation and symptomatology of a patient that presented with CECS. Patient presentation and outcomes of this case may not necessarily be the same with other individuals.

Conclusion

A patient who presented with chronic leg pain received successful treatment with bilateral fasciotomy, postsurgical rehabilitation, and chiropractic care. Clinical suspicion, a detailed history, and thorough examination were the keys toward early detection and treatment.

Funding Sources and Potential Conflicts of Interest

No funding sources or conflicts of interest were reported for this study. This case report is submitted as partial fulfillment of the requirements for the degree of Master of Science in Advanced Clinical Practice in the Lincoln College of Post-professional, Graduate, and Continuing Education at the National University of Health Sciences.

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