To diagnose CECS in patients with exercise-induced leg pain, objective IMP measurements of the lower leg, performed after an exercise test that elicits the pain, are regarded as the gold standard. It has been suggested that the pain is caused by traction of the fascia, due to increased IMP, resulting in the compression of sensory nerve endings. The abnormally elevated IMP may be related to increased muscle volume, aggravated by a muscle expansion of up to 20% during exercise, in combination with tightness of the fascia. In patients with CECS, however, the increase in IMP in the affected compartment becomes abnormally high during exercise and the time for the pressure to return to normal after activity is prolonged, leading to reduced microvascular flow. In healthy subjects, IMP increases during exercise and returns to normal on cessation of the activity. The pathophysiology of CECS is not fully understood nor is the relationship between increased IMP and pain. The treatment for CECS is fasciotomy of the affected compartments. All four compartments are associated with CECS, but the anterior compartment is the most commonly involved. There are four distinct muscle compartments in the lower leg: anterior, lateral, superficial posterior, and deep posterior. Apart from pain, patients with CECS experience muscle tightness and impaired muscle function induced by different types of exercises. ĬECS is characterized by pain triggered by exertion, attributable to increased intramuscular pressure (IMP) and reduced tissue perfusion within the muscle compartment. Further, bilateral symptoms are common, and occur in 67–95% of the patients. Patients with CECS often have long-standing symptoms, up to several years, before being diagnosed. In a retrospective review of 150 athletes with exercise-induced leg pain, the prevalence of CECS in the lower legs was reported to be 33%. The differential diagnosis includes medial tibial stress syndrome, stress fractures, popliteal artery entrapment syndrome, and nerve entrapment syndromes. Among a range of distinct entities causing exercise-induced leg pain CECS is one of the most common. Also, the diagnosis may be missed by clinicians since these patients are asymptomatic at rest and show minimal findings at physical examination. The true incidence of CECS in the general population is difficult to determine, as many people tend to modify their activities to decrease the symptoms and do not seek health care. Most patients with CECS have a high level of physical activity, with running being the most common individual sport activity and soccer being the most common team activity. Level of evidenceĬhronic exertional compartment syndrome (CECS) causes exercise-induced lower leg pain, which is most commonly experienced by sportsmen and women. These findings suggest a lowering of the IMP 1 min post-exercise cut-off value for diagnosing CECS in the lateral and both posterior compartments, which may lead to improved treatment of patients with suspected CECS in the lower leg. The study demonstrates significantly lower IMP values in the posterior and lateral compartments compared to the anterior compartments. The IMP was significantly lower in the lateral and both posterior compartments than in the anterior compartment in both patients diagnosed with CECS and patients without CECS. In patients with no CECS, the median (range) 1 min post-exercise IMP values in the compartments were 12 (2–28) mmHg (deep posterior), 12 (2–27) mmHg (superficial posterior), 14 (2–26) mmHg (lateral), and 18 (4–34) mmHg (anterior). The median (range) 1 min post-exercise IMP values in affected compartments in the patients diagnosed with CECS were 33 (25–53) mmHg (deep posterior), 35 (27–54) mmHg (superficial posterior), 40 (26–106) mmHg (lateral), and 47 (24–120) mmHg (anterior). The diagnosis of CECS was confirmed ( n = 442) or ruled out ( n = 422), based on the patient’s history, clinical examination, and IMP measurements. MethodsĪ consecutive series of patients seeking orthopaedic consultation for exertional leg pain underwent IMP measurements between 20. To investigate distributions and identify possible differences in intramuscular pressure (IMP) values at 1 min post-exercise between the four muscle compartments of the lower leg, in patients with exertional leg pain with or without chronic exertional compartment syndrome (CECS).
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