The three most commonly affected areas of chronic exertional compartment syndrome (CECS) are the lower leg, thigh, and forearm. The lower leg consists of 4 compartments: anterior, lateral, superficial posterior, deep posterior. During strenuous exercise, muscle fibers can swell up to 20 times their resting size, leading to 20% increase in the muscle volume and weight. When the blood flow is insufficient to meet the requirements of the muscle, the patient experiences pain. Measuring the intracompartmental pressures at rest and post-exercise have been shown to be the best method of confirming the diagnosis of CECS. Pedowitz et al came up with the diagnostic criteria: 1) preexercise pressure = 15mm Hg, 2) a 1 minute postexercise pressure of =30 mm Hg, or 3) a 5 minute postexercise pressure = 20 mm Hg. Management includes stopping the activities that provoke the symptoms. However, if the patient is unwilling to modify their activities, the mainstay of treatment is subcutaneous fasciotomy.
Fraipont MJ, Adamson GJ: Chronic exertional compartment syndrome. J Am Acad Orthop Surg 2003;11:268-276.
PMID:12889865 (Link to Abstract)
Pedowitz RA, Hargens AR, Mubarak SJ, et al: Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Meds 1990;18:35-40.
PMID:2301689 (Link to Abstract)