About Chronic Exertional Compartment Syndrome

Overview

Chronic exertional compartment syndrome (CECS) is a painful condition that occurs when there is abnormally increased pressure in the muscle compartment— a network of muscles, nerves, bones, and other parts that support muscle movement. When the muscle compartment is surrounded by damaged or abnormal soft tissue, it can restrict the expansion of the muscles within it. The increased pressure compromises the blood supply to the muscles and nerves in that area, leading to ischemia (lack of blood flow), muscle necrosis (tissue death), and nerve damage. CECS is often associated with repetitive activities involving specific muscle groups, such as certain sports or occupations. Symptoms typically include exercise-related muscle pain, a sensation of pressure or tightness in the affected area, which improves after stopping the activity. Diagnosis is based on a thorough history, physical examination, and sometimes painful pressure measurements. Treatment options may include surgical or non-surgical methods, depending on the severity of symptoms and response to non-surgical methods.

Causes and Risk Factors

Chronic exertional compartment syndrome (CECS) is usually exercise-induced, where the disease process involves repeated activity that causes increased pressure within the muscle compartment, resulting in reduced blood supply and eventual muscle and nerve damage.

Non-modifiable risk factors for CECS cannot be changed or controlled. These include:

Age: Younger individuals have been shown to be more likely to develop this condition.
Gender: Males have a higher risk compared to females.
High-energy injury: Injuries with significant force or trauma increase the risk.

Modifiable risk factors for CECS can be influenced or changed. These include:

Repetitive activities: Engaging in activities that involve repetitive motions, such as running, cycling, swimming, or elliptical training, increases the risk.
Intense exercise: Performing high-intensity exercises for prolonged periods can contribute to the development of CECS.

It's important to note that these risk factors can increase the likelihood of developing the condition, but they do not guarantee its occurrence. If you suspect you have CECS or have concerns about your risk factors, it is essential to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Symptoms

The most common early symptoms of chronic exertional compartment syndrome (CECS) include:

Aching, or cramping pain during exercise: People with this condition often experience pain or cramping in the affected muscle compartments during physical activity.
Tightness in the affected muscle: Some individuals may feel a sensation of tightness in the muscles of the affected compartments.

As CECS progresses or reaches higher severity, additional symptoms may occur, such as:

Numbness: Some individuals may experience numbness or tingling in the affected area.
Difficulty moving or weakness in the affected limb: As the condition worsens, it can become challenging to move affected muscle or limb properly.
Visible muscle bulging: In some cases, there may be visible muscle bulging due to increased pressure within the muscle compartments.

It's important to note that these symptoms can vary among individuals, and it's always best to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

Diagnosis

To diagnose chronic exertional compartment syndrome (CECS), the following examinations, tests, and procedures are commonly performed:

Physical exam: A healthcare provider will look for physical signs such as pain, swelling, or numbness within the affected area.
Lab tests: Blood tests may be ordered to check for any abnormalities or markers of inflammation.
Imaging studies: X-rays or MRI scans may be recommended to visualize the affected muscle compartments and rule out other conditions.
Compartmental pressure measurement: This involves inserting a needle into the affected muscle compartment before and after exercise to measure the pressure within it. Elevated pressure can indicate compartment syndrome.
Bioimpedance measurement: This non-invasive method measures electrical impedance in tissues to assess blood flow and fluid accumulation.

It's important to consult with a healthcare professional who can evaluate your specific situation and recommend appropriate examinations, tests, and procedures. They will consider your symptoms, medical history, and physical findings to guide further diagnostic steps.

Treatment Options

The goals of treatment for chronic exertional compartment syndrome (CCS) are to relieve symptoms, improve function, and prevent long-term complications. Here are the recommended treatments and how they work to achieve these goals:

Non-surgical treatments:
- Physiotherapy: Helps improve muscle strength and flexibility and teaches stretching techniques to alleviate symptoms
- Shoe inserts: Provide cushioning and support to reduce pressure on the affected compartments
- Anti-inflammatory medications: May help reduce inflammation and alleviate pain. Ask your doctor about appropriate options.
Health behavior changes:
- Avoiding activities that trigger symptoms: Resting or modifying exercise and activities that cause discomfort can help prevent symptom recurrence.
Surgical treatment:
- Fasciotomy: Involves cutting open the fascia to relieve pressure in the affected compartments. This allows the muscles to expand without compression.
- Physiotherapy after surgery: Helps restore range of motion, muscle strength, and aid in recovery

Consult your healthcare provider for personalized advice and read the information provided with your medication. Surgery should only be considered if non-surgical options have been unsuccessful.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.