Management of chronic exertional compartment syndrome

Abstract

Background. Post-exercise pain is an uncommon symptom in young, healthy adults. Rest and avoidance of exercise are frequently ineffective and poorly accepted by young, active and otherwise healthy individuals.

Methods. A total of 123 patients with extremity muscle pain, swelling and paraesthesia during the last 10 years were evaluated from a prospective database with compartment pressures and selectively evaluated with Doppler ultrasound and angiography.

Results. Patients were young (average 28 years) with long duration of symptoms (average 3.5 years), affecting both upper limbs (3), and lower limbs (120), and 80% were bilateral. Eighty-six were male (70%). All of them were taking part either in active sports or exercise programmes, mostly athletics (49%). Common symptoms were isolated muscle pain in the anterolateral compartments in all patients, paraesthesia in 15% and swelling in 10%. Post-exercise mean compartment pressure was 61 mmHg (normal <30 mmHg). Modified open fasciotomies were performed by lateral and medial incisions in lower limbs and by a single incision in upper limbs. Minor complications occurred in 11% of patients. Full relief of symptoms occurred in 90%, 7% had some improvement of symptoms, and treatment failure occurred in 3% of patients.

Conclusion. Chronic exertional compartment syndrome is underdiagnosed and should be considered as a potential cause for post-exercise pain in young individuals, and should be treated surgically. Measurement of compartment pressure is important in order to confirm the diagnosis. Open fasciotomy is safe and effective and should be considered as the preferred surgical procedure.