Delay in diagnosis of acute on chronic exertional compartment syndrome of the leg. Fasciotomy for chronic exertional compartment syndrome of. Dec 11, 2019 exerciseinduced compartment syndrome, also called exertional compartment syndrome and chronic compartment syndrome, is a condition that causes muscle pain and difficulty performing athletic activities. The lower leg has four compartments, and any one or all of them can be affected.
Compartment syndrome can be either acute or chronic. Endoscopic fascia release for forearm chronic exertional. Compartment syndrome is caused by an increase in intracompartmental pressure above the capillary. How to diagnose and treat chronic exertional compartment syndrome. Cruz md, msc, in essentials of physical medicine and rehabilitation fourth edition, 2020. Endoscopic compartment release for chronic exertional compartment syndrome. Surgery is almost always successful as long as it is performed promptly.
Extremity fasciotomy is the only recognized treatment for acute compartment syndrome. Anyone can develop the condition, but its more common in young adult runners and athletes who participate in activities that involve repetitive impact. Endoscopic thermal fasciotomy for chronic exertional. Chronic exertional compartment syndrome is an exerciseinduced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. Surgery fasciotomy is the only treatment for acute compartment syndrome. The muscle compartment is cut open to allow muscle tissue to swell, decrease pressure and restore blood flow. The high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues, causing pain, numbness and tingling. It involves cutting open the inflexible tissue encasing each of the affected muscle compartments fascia. Nov 27, 2016 learn about chronic exertional compartment syndrome with brian gruber, md, mba, board certified orthopedic surgeon. Sometimes, a fasciotomy can be performed through small incisions and this may reduce recovery.
Without treatment, it can lead to permanent muscle damage. There are 2 types of compartment syndrome, chronic exertional compartment syndrome and acute. Physicians may have difficulty differentiating cecs from other syndromes of the lower leg such as medial tibial stress. Massage therapy and compartment syndrome richard lebert. Rest and conservative interventions usually allow symptoms to resolve. Mri in diagnosing chronic exertional compartment syndrome has been found comparable to that of icp measurement 5, 1012. Management of chronic exertional compartment syndrome. Chronic exertional compartment syndrome disease reference. A surgical procedure called fasciotomy is the most effective treatment of chronic exertional compartment syndrome. Clinical bottom line compartment syndrome needs immediate surgical. Chronic exertional compartment syndrome cecs is a relatively rare condition that affects young adult athletes and often causes them to present to the emergency department.
The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport. If the difference between the resting pressure and the pressure measured immediately after exercise is too high then this is a positive test for exertional compartment syndrome. Physical therapy is initiated at two weeks after surgery and return to sports can be made at six weeks. Chronic exertional compartment syndrome of the lower. Chronic exertional compartment syndrome cecs is a wellrecognized cause of leg pain in endurance athletes.
Exertional compartment syndrome of the forearm in an elite flatwater sprint kayaker. Chronic exertional compartment syndrome cecs involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. Among the motocross racing community, this condition is more commonly referred to as arm pump. Compartment syndrome is a condition in which increased pressure within one of the bodys anatomical compartments results in insufficient blood supply to tissue within that space. Cecs is usually observed in competitive or collegiate athletes. Chronic exertional compartment syndrome cecs of the forearm is a wellknown and feared condition within the professional motocross racing circuit. Chronic exertional compartment syndrome springerlink. Compartment syndrome of the foot csf is a surgical emergency, with high risk of morbidity and poor outcome, including persistent neurologic deficits or amputation. Prevention efforts include ice and elevation of the affected. Chronic exertional compartment syndrome radiology reference.
Dec 05, 2018 chronic exertional compartment syndrome. Chronic exertional compartment syndrome cecs is a disorder that is commonly seen in athletes and is associated with repetitive exertion. However, other minimally invasive endoscopic techniques are also options. Revision surgery for exertional anterior compartment syndrome of the lower leg. Open 4 compartment fasciotomy for chronic exertional compartment syndrome of the leg by nyu langone orthopedics featuring laith jazrawi, neha jejurikar, dylan lowe, michael zacchilli, hien pham, amos dai. Chronic exertional compartment syndrome is an activityinduced condition that occurs when. Chronic exertional compartment syndrome that is refractory to conservative management should be treated with surgical fasciotomy. However, one can diagnose it accurately with a thorough history and following up on strong clinical suspicion. This pressure leads to decreased tissue perfusion and ischemic pain. Surgical fasciotomy for posterior leg cecs historically has inferior clinical results compared with anterior and lateral compartment release. Exertional compartment syndrome, chronic compartment syndrome, chronic exertional compartment syndrome, nontraumatic exertional compartment syndrome. Chronic exertional compartment syndrome cecs is a disorder commonly seen in athletes and is associated with repetitive exertion. However, owing to the limitations of intracompartmental. Thirtyfour patients identified from a surgical database who had.
Chronic exertional compartment syndrome of the lower extremity. Chronic exertional compartment syndrome cecs, first described in 1912, is a rare clinical diagnosis that occurs more frequently in the lower extremity than the upper extremity. It is due to increased pressure in the fibrosseus space. Surgical technique and results, the american journal of sports medicine, vol. The syndrome most commonly occurs in young adult recreational runners, elite athletes, and military recruits. Miniopen posterior compartment release for chronic. Surgical release of the anterior and lateral compartments of the lower leg has been shown to relieve the symptoms of chronic exertional compartment syndrome. Exertional compartment syndromes wheeless textbook of.
While acute compartment syndrome, often secondary to trauma, is a wellknown entity, chronic exertional compartment syndrome cecs is a less wellrecognised diagnosis. Chronic exertional compartment syndrome can be a debilitating cause of lower leg pain that typically. People typically experience pain after a period of highintensity activity or exercise, and it is quickly relieved by rest. Anyone can develop chronic exertional compartment syndrome, but its more common to occur in runners. Management of chronic exertional anterior compartment syndrome of the lower extremity. If left untreated, those who continue to compete at high levels may experience debilitating leg pain. Masmejeanminiinvasive surgery for chronic exertional compartment syndrome of the forearm. This page includes the following topics and synonyms. Compartments are sacs of fibrous tissue, which are a normal part of the body. Surgical decompression of exertional compartment syndrome of.
Although less common, acute compartment syndrome can occur in the thigh, buttock, and foot. Chronic exertional compartment syndrome in the forearm. Cecs is caused by increased pressure in the fibroosseus space. By nyu langone orthopedics featuring laith jazrawi, warren young, stephanie swensen, kirk campbell, amos dai, guillem lomas, daniel kaplan. Levin, endoscopic compartment release for chronic exertional compartment syndrome. Compartments of the leg or arm are most commonly involved. Diagnosis is typically made by clinical examination and compartment pressure measurement.
Fasciotomy for chronic exertional compartment syndrome of the leg. A diagnosis of chronic exertional compartment syndrome of the flexor aspect of the forearm was made and surgical decompression offered. Endoluminal minimally invasive surgery for chronic. Surgery for compartment syndrome nyu langone health. Posteromedial technique for management of tricondylar tibial plateau fractures duration. As it swells, it can become trapped in its own compartment. The purpose of this video is to demonstrate the surgical technique of a 4 compartment fasciotomy to treat chronic exertional compartment syndrome. Here we present our surgical technique, including pearls and pitfalls, for open 4 compartment fasciotomy for treatment of chronic. Measurement of intracompartmental pressures during symptom reproduction usually immediately following running is the most useful test. Exertional compartment syndrome surgery dr katherine coyner. Chronic exertional compartment syndrome cecs of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The diagnosis is in most cases obvious with cramplike pain in both forearms that may radiate to the hand. The most common site for cecs in the lower limbs is the anterior leg compartment.
Uncertainty remains regarding surgical approaches, pressure monitoring values, and the extent of surgical treatment. How to diagnose and treat chronic exertional compartment. Berlemann u, almomani z, hertel r american journal of sports medicine 263. Chronic exertional compartment syndrome is a musculoskeletal condition brought on by exercise. He was diagnosed with compartment syndrome, and uw health vascular surgeon william turnipseed was able to perform a surgery that has allowed jeff to get back to his fun. Compartment syndrome of the forearm is a condition in which pressure. Chronic exertional compartment syndrome symptoms and causes.
The leg is the most frequently affected site in the lower extremity requiring fasciotomy. Just as in acute compartment syndrome acs, the diagnosis implies a surgical. Open 4compartment fasciotomy for chronic exertional. Rehabilitation guidelines following compartment syndrome. Nov 15, 2017 compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body.
Although endoscopic techniques have been introduced, open fasciotomy remains the mainstay of surgical treatment because of the paucity of evidence in support of an endoscopic approach. Fasciotomy for chronic exertional compartment syndrome of th. Chronic exertional compartment syndrome is an uncommon but often unrecognized source of chronic extremity pain in the athletic patient. Types of activities reading physiopedia pages, journal articles, book chapters. As with the acute form, cecs can affect any of the large fascial compartments but is more recognised in the lower limb 1, 2. Chronic exertional compartment syndrome of the forearm in. This compromises the circulation and function of the tissues within that space as it compresses neural tissue, blood vessels and muscle.
The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level. Surgery for compartment syndrome at the hospital, doctors perform surgery to relieve pressure in the affected muscle compartment to avoid further damage to muscles and nerves. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement odds ratio or, 1. The purpose of this video is to demonstrate the surgical technique of a 4 compartment. Exertional compartment syndrome definition of exertional. Learn the fasciotomies of the calf for exertional compartment syndrome surgical technique with step by step instructions on orthoracle. Jun 06, 2009 chronic exertional compartment syndrome cecs is commonly misdiagnosed and often patients go though an exhaustive trial of treatments that fail to alleviate their pain. Surgical treatment of chronic exertional compartment syndrome. Chronic exertional compartment syndrome is an exerciseinduced condition that causes pain, swelling and in severe cases there is associated numbness. Chronic exertional compartment syndrome of the forearm. Jul 30, 2016 chronic exertional compartment syndrome of the lower extremity.
A novel technique for endoscopically assisted fasciotomy for chronic exertional compartment syndrome is described. Pain occurs a few minutes into a training session and requires interruption to subside and disappear within a few minutes. Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. Compartment syndrome can also be diagnosed with the use of a needle inserted into the compartment attached to a pressure monitor. Surgical decompression of exertional compartment syndrome. We utilize a technique that allows the surgeon to perform anterior and lateral compartment fasciotomies through a single incision while safely identifying the superficial peroneal nerve. It is hypothesized that physiotherapy including a change in running landing pattern and surgical fasciotomy are equally good as treatment options for chronic exertional compartment syndrome cecs of the anterior compartment of the lower leg. The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and nearinfrared spectroscopy in chronic exertional compartment syndrome. Exertional compartment syndrome statpearls ncbi bookshelf. Minimally invasive fasciotomy using a lighted retractor in the. To compare the longterm results of 2 surgical techniques for forearm chronic exertional compartment syndrome cecs in professional motorcycling racers and to study a new diagnostic variable for cecs, t rest. Our elearning platform contains high resolution images and a certified cme of the fasciotomies of the calf for exertional compartment syndrome surgical procedure.
Fasciotomies of the calf for exertional compartment. Complications may include muscle loss, amputation, infection, nerve damage, and kidney failure. A flexor compartment release was performed of the volar compartments via an incision ulnar to the midline on the volar aspect of the forearm figure 2. We describe a novel technique of miniopen fasciotomy using a lighted retractor which. Chronic exertional compartment syndrome of the forearm in elite rowers. It is most commonly seen after injuries to the leg and forearm, but also occurs in the. Chronic exertional compartment syndrome request pdf. Chronic exertional compartment syndrome in a high school. It can affect muscle compartments in any of your limbs but occurs most commonly in the lower legs.
Additional studies are needed to delineate the exact role of mri in the workup of cecs, but mri can certainly be used as a problemsolving tool in patients refusing or having contraindiations to compartment pressure. Chronic exertional compartment syndrome is usually a diagnosis of exclusion, with the hallmark finding being absence of symptoms at rest. Namely, rather than opening all compartments, only those with. The pain associated with this condition is thought to be abnormal pressure. Forearm chronic exertional hand surgery 2016 compartment. Fasciotomy is also the mainstay for surgical treatment of cecs. Surgical management for chronic exertional compartment. Exerciseinduced compartment syndrome verywell health. Compartment syndrome occurs when increased intramuscular pressure fluid hydrostatic pressure in the interstitial space of a skeletal muscle tissue impedes local muscle blood flow thereby impairing neuromuscular function of tissues within the specific compartment. Surgical management for chronic exertional compartment syndrome of the leg. Chronic exertional compartment syndrome should be on the differential for any athlete presenting with chronic exerciseinduced pain of the leg.
Excellent clinical results are noted, both in these cases and in the literature. Poor surgical technique with inadequate release may contribute to less reliable outcomes. Joe mcginley demonstrates how he uses threedimensional images of a patients legs to diagnose chronic exertional compartment syndrome. Oct 08, 2015 chronic exertional compartment syndrome cecs is a condition in athletes that can occur from repetitive loading or exertional activities.
Chronic exertional compartment syndrome cecs is a significant source of lower extremity pain and morbidity in the athletic population. Compartment syndrome of the lower leg is a condition where the pressure increases within a nonextensible space within the limb. Exertional compartment syndrome also referred to as chronic compartment syndrome treatment and surgery is available at avon and farmington, connecticut. Intermittent massage as a therapeutic option for compartment syndrome after embolectomy of the lower limbs.
Chronic exertional compartment syndrome diagnosis and. The endoscopic thermal fasciotomy technique is associated with minimal morbidity. Abstract chronic exertional compartment syndrome cecs is a significant source of lower extremity pain and morbidity in the athletic population. After positioning the patient supine on the operating table with the operative extremity prepared and draped, anatomic landmarks are identified on the patients skin. Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body. Chronic exertional compartment syndrome of the leg alicia k. Selective fasciotomy for chronic exertional compartment.
Diagnosis of chronic compartment syndrome in the forearm. In addition, patients who suffer from chronic compartment lower extremity syndromes may also benefit. Though an open fasciotomy has typically been the surgical intervention of choice, this chapter will detail the indications, contraindications, surgical technique, tips and tricks, pitfalls, postoperative management, complications, and results of a minimally invasive, endoscopic fasciotomy to treat chronic exertional compartment syndrome which. Exertional compartment syndrome is a painful condition most commonly experienced by athletes in the lower limb, but may also occur in the upper limb. Gruber is founder of integrated orthopedics, an orthopedic, sports medicine. May 24, 2016 chronic exertional compartment syndrome cecs involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. Single minimal incision fasciotomy for chronic exertional.
Casper doctor revolutionizes treatment for chronic exertional compartment syndrome by kristy bleizeffer oct 23, 20 dr. Exertional compartment syndrome is often a diagnosis of exclusion and. Physiotherapy or fasciotomy as treatment for chronic. Endoscopic compartment release for chronic exertional. The literature on surgical management of cecs is mixed, and overall. The major steps of the procedure are 1 identifying the distal end of the fibula, anterior fibular diaphysis, tibial crest, fibular head, and lateral aspect of the patella. Oct 15, 2019 though an open fasciotomy has typically been the surgical intervention of choice, this chapter will detail the indications, contraindications, surgical technique, tips and tricks, pitfalls, postoperative management, complications, and results of a minimally invasive, endoscopic fasciotomy to treat chronic exertional compartment syndrome which. Exertional compartment syndrome family practice notebook. There is a plethora of differential diagnoses for this syndrome. This book is distributed under the terms of the creative commons. Here we present our surgical technique, including pearls and pitfalls, for open 4 compartment fasciotomy for treatment of chronic exertional compartment syndrome. Chronic exertional compartment syndrome of the forearm in an.