Chronic exertional compartment syndrome
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Chronic exertional compartment syndrome is a medical condition caused by intensive, repetitive exercise or physical activity that causes the muscles in the affected legs or arms to swell, pain, and occasionally become disabled. It is not often considered an emergency and typically resolves with rest or a change in habit.
A compartment consists of a collection of muscles, nerves, and blood vessels. Each compartment is covered by a thin but firm membrane called a fascia. It helps to maintain the muscles in place. Chronic exertional compartment syndrome can cause swelling or bleeding from a serious injury or too much physical exertion in the compartment. Since the fascia is not designed to stretch to make more room, the swelling or bleeding places pressure on the nerves and muscles.
Anyone is at risk of this condition. However, it is more prevalent among young adult runners and athletes who engage in repetitive impact sports. Nonsurgical treatment and activity adjustment may help with chronic exertional compartment syndrome. If nonsurgical treatment fails, the doctor may suggest surgery.
Symptoms
The same compartment of an affected limb on both sides of the body typically experiences chronic exertional compartment syndrome. When this occurs, the patient may experience these signs and symptoms:
- Aching, burning or cramping pain in a affected limb compartment
- Tightness in the muscle
- Paresthesia, a tingling or burning sensation in the skin
- In severe cases, foot drop of the affected leg.
- Muscle hernia can cause swelling or bulging
- Weakness of limb
With chronic exertional compartment syndrome, the pressure in the compartment continues to build up which can cause pain. It typically follows a certain sequence:
- Starts occurring on a regular basis if they exercise the affected limb for a set amount of time, distance, or level of effort.
- Gets worse during workout
- Decreases in intensity or stops altogether within 15 minutes after ceasing the activity
- Rest period after exercise may lengthen over time
Chronic exertional compartment syndrome usually goes away once the exercise stops. However, symptoms may recur, once the intense or repetitive activities are performed again. Rest and modifications to the exercise routine may help relieve the condition.
Consult a healthcare provider if the symptoms persist such as unexplained discomfort, swelling, weakness, loss of sensation, or soreness while exercising or participating in sporting activities. Or if the pain does not improve with self-care.
Chronic exertional compartment syndrome is occasionally misdiagnosed as shin splints, a more prevalent cause of leg pain in young adults who engage in a lot of strenuous weight-bearing activity, such as running.
Causes
It is believed that muscles grow in size during workout. Chronic exertional compartment syndrome occurs when the fascia does not expand with the muscle, resulting in pressure and pain in a compartment of the affected area. However, the exact cause of chronic exertional compartment syndrome is still unknown.
In addition, possible causes of this condition may be due to having a very rigid fascia covering the damaged muscle compartment, or having muscle that has excessive enlargement during exercise, or having intense pressure within the veins. Some specialists believe that how people move while exercising may play a role in the development of chronic exertional compartment syndrome.
Risk factors
There are several factors that can contribute to one’s risk of getting chronic exertional compartment syndrome:
- Age: Male and female athletes under the age of 30 are more susceptible by this condition.
- Physical activity: The risk of developing this condition becomes high with impact activities or sports with very repetitive movements such as biking, running, and swimming.
- Excessive training: Chronic exertional compartment syndrome might develop if someone exercise too frequently or too intensely.
Diagnosis
The diagnosis for chronic exertional compartment syndrome often requires the patient to exercise excessively until the symptoms are felt. Through this, the doctor may observe a muscle bulging, pain, or tension in the affected area. This is done because physical examinations for chronic exertional compartment syndrome are frequently negative.
The healthcare provider may also look for signs of other medical conditions such as tendinitis, stress fractures or shin splints. Before going on to more specific testing, other exercise-related disorder must be ruled out.
- Imaging studies: To confirm the diagnosis, several imaging tests may be required:
- MRI: An advanced MRI scan has been shown to be effective in diagnosing chronic exertional compartment syndrome. This test can assist in determining the fluid contents of the compartments. Images are captured at rest, while moving the foot until symptoms appear, and after the activity.
An advanced MRI potentially reduces the requirement for invasive compartment pressure testing. A standard MRI scan of the legs can also be used to assess the structure of the muscles in the compartments and rule out other potential causes of the symptoms.
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- Near infrared spectroscopy (NIRS). This is a noninvasive procedure that assists in determining whether or not the muscle compartment has diminished blood supply. The test is done both at rest and after physical exertion. NIRS is a relatively recent technique for detecting oxygen amount in the blood in the injured area.
- Compartment pressure measurement: Compartment pressure measurement is often recommended if the medical history and initial test results points to chronic exertional compartment syndrome. Or if the imaging tests do not reveal a stress fracture or other source of pain.
During the procedure, a needle or catheter is inserted into the muscle before and after activity. The pressure will be measured using a machine attached to the needle. The needle may be inserted in numerous locations.
This test is considered the gold standard for diagnosing chronic exertional compartment syndrome. However, it is normally avoided because it is invasive and moderately painful.
Treatment
Nonsurgical and surgical treatments are available for chronic exertional compartment syndrome. Nonsurgical treatment may include medications or making changes in the exercise routine. The condition often gets better with rest from intense or repetitive activity. If the condition does not improve, surgical treatment such as fasciotomy may be necessary.
Nonsurgical options
Modifications in the exercise routine such as changing how to properly land the feet when jogging or running, mixing up exercise types instead of doing the same thing, switching to low-impact exercise, or using orthotics can help manage chronic exertional compartment syndrome. Physical therapy, massage, and pain relievers may also be the treatment options.
Botulinum toxin A (Botox) injections into the affected muscle may help cure chronic exertional compartment syndrome. The doctor may use anesthetic injections prior to the procedure to help identify the affected area and establish the appropriate Botox dose. Although this may be recommended, further research on this treatment is still needed.
Nonsurgical options are often suggested to provide temporary relief from chronic exertional compartment syndrome. However, it does not provide lasting benefit because the symptoms may recur once intense or repetitive exercise is resumed.
Surgical options
Fasciotomy is an invasive procedure that entails severing the inflexible tissue that surrounds each afflicted muscle compartment. An incision through the skin and fascia is made to release pressure.
Fasciotomy is considered the most effective treatment for chronic exertional compartment syndrome. However, it is not without risk. Infection, lasting nerve injury, numbness, paralysis, bruising, and scarring are all possible complications of the procedure.
A fasciotomy can be done using minor incisions, reducing recuperation time and allowing patients to resume to their normal activities sooner, including exercise and sports.
