Topics in Sports MedicineChronic Exertional Compartment Syndrome in a Healthy Young Man
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.
References (31)
- et al.
Lateral compartment syndrome of the lower extremity in a recreational athlete: a case report
Am J Emerg Med
(2008) - et al.
Chronic exertional compartment syndrome, the controversial “fifth” compartment of the leg
Am J Sports Med
(2003) Chronic exertional compartment syndrome
Br J Sports Med
(2011)- et al.
Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome
Curr Sports Med Rep
(2003) - et al.
Histology of the fascial-periosteal interface in lower limb chronic deep posterior compartment syndrome
Br J Sports Med
(2004) - et al.
Exercise induced compartment syndrome in a professional footballer
Br J Sports Med
(2004) - et al.
How a footballer got hurt without getting hit: isolated peroneal compartment syndrome of a non-traumatic cause
Ann R Coll Surg Engl
(2007) - et al.
Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study
J Orthop Surg Res
(2013) - et al.
Chronic exertional compartment syndrome in a collegiate soccer player, a case report and literature review
Am J Orthop
(2008) - et al.
Gait re-training to alleviate the symptoms of anterior exertional lower leg pain, ac case series
Int J Sports Phys Ther
(2015)
Chronic deep posterior compartment syndrome of the leg in athletes: postoperative results of fasciotomy
Int J Sports Med
Pathology and diagnostic options of lower limb compartment syndrome
Clin Hemorheol Microcirc
Posterior thigh compartment syndrome as a result of a basketball injury
Orthopedics
Painless, atraumatic, isolated lateral compartment syndrome of the leg: an unusual triad of atypical findings
Am J Orthop (Belle Mead NJ)
Chronic leg pain in athletes
Am J Sports Med
Cited by (3)
Chronic exertional compartment syndrome of the quadriceps femoris
2024, Radiology Case ReportsChronic Exertional Compartment Syndrome
2021, The Female AthleteMay Thurner syndrome revealed by left calf venous claudication during running, a case report
2018, Standards in Genomic Sciences