Chronic Exertional Compartment Syndrome
By Steven Meier
Also known as chronic compartment syndrome, or exercise-induced compartment syndrome, exertional compartment syndrome is a condition that typically results from repetitive impact sports and exercises, like long distance running and speed walking. Chronic exertional compartment syndrome differs from acute compartment syndrome, which can also result from blunt force trauma injuries to the extremities in some cases (acute compartment syndrome), and therefore anyone can suffer from the condition.
However, many have never heard of chronic exertional compartment syndrome and may not be aware of symptoms indicating the presence of a condition affecting their bodies. If you or a loved one is experiencing physical limitations that may be the result of an orthopedic injury, get in touch with Meier Orthopedic Sports and Regenerative Medicine in Beverly Hills today by calling 310.736.2793 or filling out the online contact form.
What is Compartment Syndrome?
Groups of muscles, blood vessels, and nerves are encased together within a membrane called the fascia. The fascia is a sheet-like type of connective tissue that covers and contains muscles and other soft tissue, encasing them in a “compartment.”
Compartment syndrome occurs when an injury or activity causes the muscle to swell beyond capacity, resulting in a build up of pressure on the nerves and blood vessels within the fascia compartment. The swelling and pressure disrupt blood flow to the muscles, essentially cutting off circulation. In acute compartment syndrome, this can result in tissue death or necrosis and permanent scarring or fibrosis if left untreated, rendering the muscle permanently nonfunctional. In chronic exertional compartment syndrome, muscle swelling associated with exercise results in extreme pain in the extremity, making exercise very uncomfortable and, in some cases, intolerable.
Compartment syndrome most often affects the lower legs and forearms but can also affect the thighs, buttocks, feet and hands.
Compartment Syndrome Causes
Chronic exertional compartment syndrome develops most commonly in association with repetitive impact activities like running. Because blood flow to the muscles increases during physical exertion, the muscles naturally expand during exercise. In cases where the surrounding fascia does not expand along with the muscles, the resulting pressure can cut off the blood flow to the muscles and cause compartment syndrome, essentially creating a tourniquet effect.
Runners who are susceptible to chronic exertional compartment syndrome may have one or more factors that have been identified as potential triggers for the condition.
- Venous Hypertension
- Enlarged or Hypertrophied Muscles
- Hardened or Thicker Fascia
Chronic Compartment Syndrome Symptoms
The most common symptoms of chronic exertional compartment syndrome include pain that begins soon after physical activity and becomes progressively worse, and typically ceases within 30 minutes of completing the physical activity. Over time, the pain can become more intense and linger for longer periods of time. Other major symptoms, include:
- Numbness and Tingling
Diagnosing Chronic Exertional Compartment Syndrome
Chronic exertional compartment syndrome can be difficult to diagnose. Unlike other sports-related injuries like an acl tear or rotator cuff tear, where the pain and symptoms present almost immediately, or shortly after the initial injury, the symptoms of exertional compartment syndrome do not usually appear right away. The most severe symptoms typically manifest only during physical exertion and often disappear at rest. Many physicians may not know what to look for in patients suffering from the symptoms of this condition. Patients with chronic exertional compartment syndrome often get misdiagnosed with other conditions.
Dealing with chronic exertional compartment syndrome can be very troubling for active individuals. They’re ability to compete and perform becomes limited and this often results in frustration.
An important part of diagnosing chronic exertional compartment syndrome is taking a detailed history from the patient, determining the location and character of the pain and timing of onset and cessation as it relates to beginning the ending physical activities. A physician who is experienced in the management of chronic exertional compartment syndrome will have a high index of suspicion for the correct diagnosis based on history alone. Next, diagnostic testing is necessary to confirm the provisional diagnosis.
It is important to rule out other causes of activity-related pain such as tendinitis and stress fractures.
Imaging tests like X-rays and MRIs can be helpful in ruling out other conditions but the most direct way to diagnosis chronic exertional compartment syndrome is to measure muscle compartment pressures before, during and after the physical activity that normally causes the symptoms. This is accomplished using an intra-compartmental pressure measuring device that has a needle which is inserted into the muscle compartment to be measured. There are a total of 4 compartment in the lower leg. All suspected muscle compartments are measured before, during and after exercise. Exercise is typically performed by having the patient run on a treadmill until the symptoms occur.
Treatment for Chronic Exertional Compartment Syndrome
When conservative treatments like rest, physical therapy and a temporary break from the physical activity causing the condition are not sufficient, surgical treatment can be considered with the intent to permanently address the condition. Surgical treatment consists of fasciotomy in which the fascia covering the muscle compartment is released thereby allowing the muscle to expand normally during exercise without a build up of pressure within a restrictive muscle compartment. Traditional fasciotomy surgery has required the use of relatively large incisions but newer endoscopic techniques allow the procedure to be carried out through small incisions with better visualization allowing the surgery to result in greater success and with greater safety to nerves and other vital structures.
When chronic exertional compartment syndrome is treated effectively, patients generally have a very good prognosis and are able to return to their desired levels of physical activity.
Find Compartment Syndrome Care from a Skilled Orthopedic Surgeon
Contact Meier Orthopedic Sports and Regenerative Medicine in Beverly Hills today at 310.736.2793 to learn more about the accurate diagnosis and effective treatment options for chronic exertional compartment syndrome, or schedule an appointment online.