Compartment Syndrome

Chronic exertional compartment syndrome is a painful condition that develops due to excessive pressure on muscle and nerve.

Swelling of the affected limb is common. It may also lead to disability of the affected part.

Though anyone can develop this condition, it mostly occurs in athletes who suffer from repeated impact, such as due to running.

Chronic exertional compartment syndrome can be treated by non-operative measures and activity modification.

If nonsurgical treatments fail, you can consider surgery to return to your previous activities or sport. 

The signs and symptoms of chronic exertional compartment syndrome are:

• Excruciating pain in the affected limb, mostly the lower leg
• Tightness in the affected limb
• Numbness or tingling sensation in the affected limb
• Weakness of the affected limb
• Foot drop (foot dragging due to weakness)
• Inflammation or protrusion of affected muscle

Pain in your affected leg usually begins after you start exercising. The pain worsens as you continue to exercise. The pain disappears 10 to 20 minutes after discontinuation of exercise.

As the disease progresses, it takes more time for pain to disappear after exercise. Once you stop exercising or start doing low-impact activity, your symptoms may go away but only for a short period of time.

The symptoms start appearing again when you resume your activities.

When to see a doctor?

Make an appointment with your doctor if you feel severe pain during exercise or sports activities. Exercising during pain can further damage muscle or nerve.

Chronic exertional compartment syndrome can be misdiagnosed with shin splints, which causes leg pain in young people who perform vigorous weight-bearing activity, such as running.

If your shin splints still persist despite self-care, see your doctor.

The cause of chronic exertional compartment syndrome is unknown. The symptoms begin when pressure in a muscle compartment is increased.

During exercise, blood flow to muscles is increased, which causes expansion of muscles. Pressure in muscle compartment builds up if the connective tissue (fascia) binding the muscle fiber doesn’t expand.

Over time the pressure limits blood supply to the muscles. The way you move (biomechanics) can also cause chronic exertional compartment syndrome.

Venous hypertension (increased blood pressure in your veins), enlarged muscles, thick or inelastic fascia binding a section of muscle are other probable causes.

Diagnosis of chronic exertional compartment syndrome usually begins with physical exams. Chronic exertional compartment syndrome is less common, so your doctor may first try to rule out more obvious causes such as shin splints or stress fractures before moving on to more specialized testing. 

Your doctor can also determine what level of activity causes the symptoms to appear. Your doctor may observe a muscle protrusion (hernia), tenderness or tension in the affected area.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be

Ask a friend or a family member to accompany you during the visit.

• What could be the most probable cause of my symptoms?
• What are the tests that I need?
• How long will my condition last?
• What are my treatment options and which one is most suitable for me?
• Can lifestyle modifications help me?
• Do I need to take some medications and what are their possible side effects?
• Do I need to limit my activities?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did your symptoms start appearing?
• Do you experience pain while exercising, at rest or both?
• How would you like to rate your pain on a scale of 1 to 10?
• Does anything improve or worsen your symptoms?
• Does sitting down or standing still relieve your symptoms?

The tests for diagnosis of chronic compartment syndrome may include:

Imaging studies

Imaging studies such as MRI or near infrared spectroscopy (NIRS) may be performed to assess the structure of the muscles and to check if your symptoms are caused by other medical condition.

An innovative MRI scan can measure fluid volumes of muscle compartments throughout exercise. It can detect compartment syndrome precisely, and reduce the need of invasive compartment pressure testing.

NIRS utilizes “light” to evaluate tissue oxygen saturation in your blood. This helps to find out if the blood flow to muscle compartment is decreased.

Compartment pressure testing

Also called compartment pressure measurement, it precisely detects chronic exertional compartment syndrome and is recommended when imaging studies are not able to diagnose the cause of your symptoms.

Other tests

Your doctor may also recommend other tests such as CT scan, ultrasound and X-ray.

Chronic exertional compartment syndrome can be treated either by non-surgical measures or a surgery.

Non-surgical measures

These measures may work if you start practicing them soon after the symptoms appear.

Some of these measures include:

• Pain medications
• Proper warm up: Pre-exercise stretching or strengthening activities may help reduce severity of pain
• Orthotics: Foot orthotics can correct the movement of your foot while running.
• Massage: Massaging the affected part can reduce pain.
• Discontinuation of exercise
• Modifying biomechanical techniques, such as using techniques that allow soft landing.

But non-operative measures have not proved to be beneficial for long term if you have true chronic exertional compartment syndrome.

Surgical treatment

Surgery to remove fascia of the affected compartment is the definitive treatment for chronic exertional compartment syndrome.

In this process, the fascia of affected compartment is either cut and opened (fasciotomy) or removed (fasciectomy). Surgery may cause:

• infection,
• permanent nerve damage,
• numbness,
• scarring.

There are different ways to adapt your lifestyle in coping with chronic exertional compartment syndrome.

Following tips might reduce pain associated with chronic exertional compartment syndrome:

• Use athletic shoe inserts (orthotics) or wear athletic shoes that absorb shock while landing.

• Perform low impact physical activities, such as cycling or elliptical trainer, which don’t cause pain. For instance, if running causes pain you may choose swimming.

• Applying ice to the affected area after exercising can be helpful.