Chronic Exertional Compartment Syndrome in Athletes: An Overview of the Current Literature

Abstract

Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.

Keywords: cecs; chronic exertional compartment syndrome; fascial hernias; intramuscular compartment pressure measurement; medial tibial stress syndrome; muscle cramps; muscle tightness and weakness; pain; paresthesia; stress fractures.

Figure 1. Isolated lateral compartment syndrome of a lower leg

(a) Coronal fat-suppressed T2-weighted image shows a diffuse high signal intensity of the peroneus longus and brevis muscles (long arrows). Fluid signal intensity is noted within the surrounding deep and superficial fascial planes (arrowheads). (b) Axial T1-weighted image of the lower leg shows marked swelling of the peroneus longus and brevis muscles with peripheral convex indentation (arrow). (c) Axial fat-suppressed T2-weighted image shows a diffuse high signal intensity of the peroneus longus and brevis muscles (long arrows). Fluid signal intensity is noted within the surrounding deep and superficial fascial planes (arrowheads). Focal increased signal intensity suspected reactive change is noted in the extensor digitorum longus and soleus muscles around the peroneus longus muscle (short arrows). (d) Axial gadolinium-enhanced T1-weighted image shows heterogeneous enhancement within the affected muscles of the lateral compartment (arrow). Reprinted from Creative Commons under (CC BY-NC 3.0), copy and redistributable material [23].