Chronic exertional compartment syndrome

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.

• • 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.