Materiały źródłowe

• #1 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  Chronic exertional compartment syndrome is typically considered a rare cause of lower extremity pain, with a reported incidence rate in active patients presenting with exercise-induced leg pain to be 33%. […] Waterman et al., in their retrospective study involving a military population, showed an average annual incidence of 0.49 per 1000 at-risk person-years. CECS is relatively common, especially among young adult athletes involved in running, endurance training, soccer, field hockey, and lacrosse. […] CECS predominantly affects the anterior compartment, representing up to 70% of cases in some series. Other reports cite the anterior and deep posterior compartments are the most frequently affected compartments (25% each), and simultaneous anterior and deep posterior involvement can happen in 8 to 10% of cases.

• #2 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  Lower limb exertional compartment syndrome (LLECS), also known as chronic exertional compartment syndrome (CECS), is an overuse syndrome characterized by exercise-induced elevation of intramuscular pressures (IMP) that results in reproducible transient pain, paresthesias, and neuromuscular dysfunction. […] The incidence of LLECS in the general population is unknown, although some estimate that it accounts for 14-27% of previously undiagnosed exercise-induced leg pain. […] A vast majority (87%) of patients with LLECS participate in sports, with running accounting for 69%. […] LLECS has a median age of onset of 20 years old, and the prevalence decreases with age, though it has been suggested that there is an underdiagnosed population within older adults, plateauing around age 50. […] Bilateral lower extremity involvement occurs in 85-95% of cases with a predilection for the anterior and deep compartments.

• #3 Compartment Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/compartment-syndrome-pro

  Chronic exertional compartment syndrome has an incidence of 33% in active patients with exercise-induced leg pain. […] A study of a military population reported an annual incidence of 0.49 per 1,000 at-risk person-years. […] The condition has a peak prevalence of 20-25 years. […] Most at risk are those who exercise with repetitive motions or activity. […] Sporting activities with particular risk include running, football, cycling, tennis and gymnastics. […] Excessive training increases the risk.

• #4 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  Lower limb exertional compartment syndrome (LLECS), also known as chronic exertional compartment syndrome (CECS), is an overuse syndrome characterized by exercise-induced elevation of intramuscular pressures (IMP) that results in reproducible transient pain, paresthesias, and neuromuscular dysfunction. […] The incidence of LLECS in the general population is unknown, although some estimate that it accounts for 14-27% of previously undiagnosed exercise-induced leg pain. […] A vast majority (87%) of patients with LLECS participate in sports, with running accounting for 69%. […] LLECS has a median age of onset of 20 years old, and the prevalence decreases with age, though it has been suggested that there is an underdiagnosed population within older adults, plateauing around age 50. […] Bilateral lower extremity involvement occurs in 85-95% of cases with a predilection for the anterior and deep compartments.

• #5 Demographic Characteristics Among Patients With Chronic Exertional Compartment Syndrome of the Lower Leg in: Journal of Sport Rehabilitation Volume 29 Issue 8 (2020)

  https://journals.humankinetics.com/view/journals/jsr/29/8/article-p1214.xml

  Chronic exertional compartment syndrome (CECS) is a condition related with ischemia of the bodys tissue due to increases in intracompartmental pressures, which involves, among other symptoms, pain with exertion. CECS is often overlooked or misdiagnosed due to an ambiguous presentation. […] Research is lacking on the type of patient most likely to experience CECS, highlighting the need for identification of common demographic characteristics among affected individuals. […] Current evidence has identified commonalities in sex, age, and sport participation as characteristics often present among individuals experiencing lower leg CECS. […] There is level B evidence in support of certain sex, age, and sport participation demographics as common characteristics among those experiencing CECS of the lower leg.

• #6 Diagnosis of chronic exertional compartment syndrome in primary care | British Journal of General Practice

  https://bjgp.org/content/65/637/e560

  Chronic exertional compartment syndrome (CECS) is a disorder that typically presents as bilateral lower leg pain during exercise but is absent at rest. This is due to compression of a fascial compartment causing pain during exercise. It commonly presents in primary care but is often under-diagnosed due to a lack of awareness of the ailment by both patients and practitioners. If left undiagnosed it can lead to ischaemia and then infarction of the affected muscle compartment. […] CECS is often overlooked as a cause of muscle pain and there can be as much as a 22-month delay in the diagnosis of the condition. It has a widely varying incidence, which has been reported to be between 10-64%. This is because CECS can present with many different symptoms and can therefore be easily misdiagnosed. Patients often only seek medical attention at a late stage, as they believe it to be a less serious disorder. Classically it presents as a burning, aching, or bursting pain in both legs, which occurs only during exercise and completely ceases at rest. The symptoms are more likely to be bilateral with figures between 70-90% quoted in various studies. The anterior compartment is most commonly affected. GPs should examine the patient both before and after exertion to demonstrate a normal physical examination pre-exercise and a possible bulge in the affected compartment together with pain on palpation and possible neurovascular compromise in the affected area post-exercise. CECS is prevalent equally in both sexes with a median age of onset of 20-years-old and is associated with diabetes mellitus.

• #7 Chronic Exertional Compartment Syndrome in ­Athletes: A narrative Review – SEMS-journal

  https://sems-journal.ch/8207

  Chronic exertional compartment syndrome of the lower leg accounts for approximately 75% of sports-related chronic leg pain. […] At present, chronic exertional compartment syndrome (CECS) of the lower leg accounts for up to 75% of sports-related chronic leg pain in endurance athletes. […] It represents a overuse muscle injury affecting mostly well-conditioned young athletes (particularly runners) with a median age of 20 years. […] Athletes that participate in endurance sports, particularly long distance running, soccer, and ballet or squash are primarily at risk of developing CECS.

• #8 Chronic exertional compartment syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-exertional-compartment-syndrome?embed_domain=hackmd.io%2F%40yIPUAFeCSL2JsU8smR5nJQ%2Fbnjhjgjghjghjghfavicon.icoradiopaedia-icon-144.pngfavicon.icoradiopaedia-icon-144.png&lang=us

  Chronic exertional compartment syndrome (CECS), previously known as anterior tibial syndrome, is a type of compartment syndrome that is brought on by exercise. […] The exact prevalence is not known since sufferers may modify the way they exercise and therefore never present. CECS can present at any age and any level of physical activity. There is no sex predilection. CECS occurs bilaterally in 70-80%.

• #9 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  Chronic exertional compartment syndrome is typically considered a rare cause of lower extremity pain, with a reported incidence rate in active patients presenting with exercise-induced leg pain to be 33%. […] Waterman et al., in their retrospective study involving a military population, showed an average annual incidence of 0.49 per 1000 at-risk person-years. CECS is relatively common, especially among young adult athletes involved in running, endurance training, soccer, field hockey, and lacrosse. […] CECS predominantly affects the anterior compartment, representing up to 70% of cases in some series. Other reports cite the anterior and deep posterior compartments are the most frequently affected compartments (25% each), and simultaneous anterior and deep posterior involvement can happen in 8 to 10% of cases.

• #10 Compartment Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/compartment-syndrome-pro

  Chronic exertional compartment syndrome has an incidence of 33% in active patients with exercise-induced leg pain. […] A study of a military population reported an annual incidence of 0.49 per 1,000 at-risk person-years. […] The condition has a peak prevalence of 20-25 years. […] Most at risk are those who exercise with repetitive motions or activity. […] Sporting activities with particular risk include running, football, cycling, tennis and gymnastics. […] Excessive training increases the risk.

• #11

  https://journals.lww.com/acsm-csmr/fulltext/2023/06000/the_pressure_is_rising__evaluation_and_treatment.6.aspx

  Chronic exertional compartment syndrome is a condition that typically affects athletic/active individuals. Chronic exertional compartment syndrome predominantly affects the lower leg; however, there are cases involving the hand, forearm, foot, and thigh. […] CECS is a fairly common occurrence in young athletes (25 years or younger), especially those in running, skating, dance, as well as military training where there are repetitive activities. While this can affect upper and lower limbs, the lower extremity is more commonly pathologic with an incidence of 1 in 2000 persons/year. The anterior compartment of the lower leg is the most often reported, being affected in about 70% of cases. The incidence rate in military service members is especially high at 0.49 per 1000 person-years for CECS.

• #12 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  The United States military is considered a high-risk cohort with an adjusted annual incidence of up to 0.33-0.5 cases per 1000 person-years. […] Most recently, a large study has found equal prevalence of CECS in males and females, however, males were more likely to receive a diagnosis of CECS. […] In the pediatric population, one study has suggested that females are at highest risk of LLECS with a peak age incidence of 16 years-old. […] Chronic exertional compartment syndrome predominantly affects the lower leg, although CECS may also present in the upper extremity and rarely in the upper leg.

• #13 Registry Development and Non-Surgical Treatment Options for Chronic Exertional Compartment Syndrome — MIRROR | Musculoskeletal Injury Rehabilitation Research for Operational Readiness

  https://mirrorusuhs.org/mirror-projects/project5

  Chronic exertional compartment syndrome (CECS) is a debilitating disorder affecting mostly an active population. CECS involves the lower extremities, primarily affects young active adults, and limits running and/or endurance activities. While the incidence of CECS in the general population is unknown, the prevalence in the military population has been found to be 0.49 cases per 1000 patient-years. […] The current standard for definitive treatment of CECS is surgical fasciotomy of the involved compartments. According to a 2016 systematic review, surgical intervention for CECS is successful in only 66% of those affected, with 13% of patients reporting complications from surgery, and 6% needing a repeat procedure. A 2014 retrospective review of military members showed that only 59% of patients who underwent elective fasciotomy for CECS were able to return to full duty while 22% of the patients that were treated with fasciotomy were eventually medically discharged.

• #14 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  Lower limb exertional compartment syndrome (LLECS), also known as chronic exertional compartment syndrome (CECS), is an overuse syndrome characterized by exercise-induced elevation of intramuscular pressures (IMP) that results in reproducible transient pain, paresthesias, and neuromuscular dysfunction. […] The incidence of LLECS in the general population is unknown, although some estimate that it accounts for 14-27% of previously undiagnosed exercise-induced leg pain. […] A vast majority (87%) of patients with LLECS participate in sports, with running accounting for 69%. […] LLECS has a median age of onset of 20 years old, and the prevalence decreases with age, though it has been suggested that there is an underdiagnosed population within older adults, plateauing around age 50. […] Bilateral lower extremity involvement occurs in 85-95% of cases with a predilection for the anterior and deep compartments.

• #15 Chronic Exertional Compartment Syndrome in ­Athletes: A narrative Review – SEMS-journal

  https://sems-journal.ch/8207

  Chronic exertional compartment syndrome of the lower leg accounts for approximately 75% of sports-related chronic leg pain. […] At present, chronic exertional compartment syndrome (CECS) of the lower leg accounts for up to 75% of sports-related chronic leg pain in endurance athletes. […] It represents a overuse muscle injury affecting mostly well-conditioned young athletes (particularly runners) with a median age of 20 years. […] Athletes that participate in endurance sports, particularly long distance running, soccer, and ballet or squash are primarily at risk of developing CECS.

• #16

  https://www.orthobullets.com/knee-and-sports/3106/exertional-compartment-syndrome

  Exertional compartment syndrome is an exercise-induced condition of the extremity characterized by reversible ischemia to muscles within a muscular compartment. […] Epidemiology: Incidence: second most common exercise induced leg syndrome behind medial tibial stress syndrome. […] Demographics: males females, often seen in 3rd decade of life, runners or those who run a lot for their sport. […] Anatomic location: anterior leg compartment most commonly affected (~70%), anterior and lateral leg compartment affected in 10%. […] Posterior leg compartment involvement associated with less predictable surgical outcomes, more frequently associated with popliteal artery entrapment syndrome (PAES). […] Most common cause is the presence of an accessory head of the medial gastrocnemius muscle. […] Volar forearm less commonly encountered, but occurs in sports requiring repetitive gripping. […] Volar forearm compartment most commonly affected.

• #17 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  Lower limb exertional compartment syndrome (LLECS), also known as chronic exertional compartment syndrome (CECS), is an overuse syndrome characterized by exercise-induced elevation of intramuscular pressures (IMP) that results in reproducible transient pain, paresthesias, and neuromuscular dysfunction. […] The incidence of LLECS in the general population is unknown, although some estimate that it accounts for 14-27% of previously undiagnosed exercise-induced leg pain. […] A vast majority (87%) of patients with LLECS participate in sports, with running accounting for 69%. […] LLECS has a median age of onset of 20 years old, and the prevalence decreases with age, though it has been suggested that there is an underdiagnosed population within older adults, plateauing around age 50. […] Bilateral lower extremity involvement occurs in 85-95% of cases with a predilection for the anterior and deep compartments.

• #18 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  There are reports of bilateral limb involvement in 37 to 82% of symptomatic athletes. […] In a retrospective study, Brujin et al. looked at 1411 heterogeneous patients who had complaints of lower extremity pain and had dynamic intracompartmental pressures performed. Of the 1411 patients included in the study, 698 patients had a diagnosis of CECS. […] CECS demonstrated a peak prevalence at 20 to 25 years of age and a higher likelihood in males than females and was present bilaterally in the majority of cases. It occurred in patients that participated in sports like running or skating, and higher activity intensities correlated with a higher likelihood of CECS. However, it is important to note that CECS may occur in patients not involved in sporting activity.

• #19 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  Lower limb exertional compartment syndrome (LLECS), also known as chronic exertional compartment syndrome (CECS), is an overuse syndrome characterized by exercise-induced elevation of intramuscular pressures (IMP) that results in reproducible transient pain, paresthesias, and neuromuscular dysfunction. […] The incidence of LLECS in the general population is unknown, although some estimate that it accounts for 14-27% of previously undiagnosed exercise-induced leg pain. […] A vast majority (87%) of patients with LLECS participate in sports, with running accounting for 69%. […] LLECS has a median age of onset of 20 years old, and the prevalence decreases with age, though it has been suggested that there is an underdiagnosed population within older adults, plateauing around age 50. […] Bilateral lower extremity involvement occurs in 85-95% of cases with a predilection for the anterior and deep compartments.

• #20 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  Chronic exertional compartment syndrome is typically considered a rare cause of lower extremity pain, with a reported incidence rate in active patients presenting with exercise-induced leg pain to be 33%. […] Waterman et al., in their retrospective study involving a military population, showed an average annual incidence of 0.49 per 1000 at-risk person-years. CECS is relatively common, especially among young adult athletes involved in running, endurance training, soccer, field hockey, and lacrosse. […] CECS predominantly affects the anterior compartment, representing up to 70% of cases in some series. Other reports cite the anterior and deep posterior compartments are the most frequently affected compartments (25% each), and simultaneous anterior and deep posterior involvement can happen in 8 to 10% of cases.

• #21 Chronic Exertional Compartment Syndrome in ­Athletes: A narrative Review – SEMS-journal

  https://sems-journal.ch/8207

  Chronic exertional compartment syndrome of the lower leg accounts for approximately 75% of sports-related chronic leg pain. […] At present, chronic exertional compartment syndrome (CECS) of the lower leg accounts for up to 75% of sports-related chronic leg pain in endurance athletes. […] It represents a overuse muscle injury affecting mostly well-conditioned young athletes (particularly runners) with a median age of 20 years. […] Athletes that participate in endurance sports, particularly long distance running, soccer, and ballet or squash are primarily at risk of developing CECS.

• #22 Chronic exertional compartment syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-exertional-compartment-syndrome/symptoms-causes/syc-20350830

  Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. […] Anyone can develop the condition, but it’s more common in young adult runners and athletes who participate in activities that involve repetitive impact. […] Chronic exertional compartment syndrome is a musculoskeletal condition brought on by exercise. It can affect muscle compartments in any of your limbs but occurs most commonly in the lower legs. […] Certain factors increase your risk of developing chronic exertional compartment syndrome, including: […] Although people of any age can develop chronic exertional compartment syndrome, the condition is most common in male and female athletes under age 30.

• #23 Chronic exertional compartment syndrome | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/chronic-exertional-compartment-syndrome?content_id=CON-20155275

  Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. […] Anyone can develop the condition, but it’s more common in young adult runners and athletes who participate in activities that involve repetitive impact. […] Certain factors increase your risk of developing chronic exertional compartment syndrome, including: Age. Although people of any age can develop chronic exertional compartment syndrome, the condition is most common in male and female athletes under age 30. […] Type of exercise. Repetitive impact activity such as running increases your risk of developing the condition. […] Overtraining. Working out too intensely or too frequently also can raise your risk of chronic exertional compartment syndrome.

• #24 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  There are reports of bilateral limb involvement in 37 to 82% of symptomatic athletes. […] In a retrospective study, Brujin et al. looked at 1411 heterogeneous patients who had complaints of lower extremity pain and had dynamic intracompartmental pressures performed. Of the 1411 patients included in the study, 698 patients had a diagnosis of CECS. […] CECS demonstrated a peak prevalence at 20 to 25 years of age and a higher likelihood in males than females and was present bilaterally in the majority of cases. It occurred in patients that participated in sports like running or skating, and higher activity intensities correlated with a higher likelihood of CECS. However, it is important to note that CECS may occur in patients not involved in sporting activity.

• #25 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  The United States military is considered a high-risk cohort with an adjusted annual incidence of up to 0.33-0.5 cases per 1000 person-years. […] Most recently, a large study has found equal prevalence of CECS in males and females, however, males were more likely to receive a diagnosis of CECS. […] In the pediatric population, one study has suggested that females are at highest risk of LLECS with a peak age incidence of 16 years-old. […] Chronic exertional compartment syndrome predominantly affects the lower leg, although CECS may also present in the upper extremity and rarely in the upper leg.

• #26 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  The United States military is considered a high-risk cohort with an adjusted annual incidence of up to 0.33-0.5 cases per 1000 person-years. […] Most recently, a large study has found equal prevalence of CECS in males and females, however, males were more likely to receive a diagnosis of CECS. […] In the pediatric population, one study has suggested that females are at highest risk of LLECS with a peak age incidence of 16 years-old. […] Chronic exertional compartment syndrome predominantly affects the lower leg, although CECS may also present in the upper extremity and rarely in the upper leg.

• #27 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  Lower limb exertional compartment syndrome (LLECS), also known as chronic exertional compartment syndrome (CECS), is an overuse syndrome characterized by exercise-induced elevation of intramuscular pressures (IMP) that results in reproducible transient pain, paresthesias, and neuromuscular dysfunction. […] The incidence of LLECS in the general population is unknown, although some estimate that it accounts for 14-27% of previously undiagnosed exercise-induced leg pain. […] A vast majority (87%) of patients with LLECS participate in sports, with running accounting for 69%. […] LLECS has a median age of onset of 20 years old, and the prevalence decreases with age, though it has been suggested that there is an underdiagnosed population within older adults, plateauing around age 50. […] Bilateral lower extremity involvement occurs in 85-95% of cases with a predilection for the anterior and deep compartments.

• #28 Chronic exertional compartment syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-exertional-compartment-syndrome?embed_domain=hackmd.io%2F%40yIPUAFeCSL2JsU8smR5nJQ%2Fbnjhjgjghjghjghfavicon.icoradiopaedia-icon-144.pngfavicon.icoradiopaedia-icon-144.png&lang=us

  Chronic exertional compartment syndrome (CECS), previously known as anterior tibial syndrome, is a type of compartment syndrome that is brought on by exercise. […] The exact prevalence is not known since sufferers may modify the way they exercise and therefore never present. CECS can present at any age and any level of physical activity. There is no sex predilection. CECS occurs bilaterally in 70-80%.

• #29 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  There are reports of bilateral limb involvement in 37 to 82% of symptomatic athletes. […] In a retrospective study, Brujin et al. looked at 1411 heterogeneous patients who had complaints of lower extremity pain and had dynamic intracompartmental pressures performed. Of the 1411 patients included in the study, 698 patients had a diagnosis of CECS. […] CECS demonstrated a peak prevalence at 20 to 25 years of age and a higher likelihood in males than females and was present bilaterally in the majority of cases. It occurred in patients that participated in sports like running or skating, and higher activity intensities correlated with a higher likelihood of CECS. However, it is important to note that CECS may occur in patients not involved in sporting activity.

• #30 Chronic exertional compartment syndrome of the forearm: a systematic review in: EFORT Open Reviews Volume 6 Issue 2 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/2/2058-5241.6.200107.xml

  The aim of this systematic review is to understand which surgical procedure provides better results in terms of pain relief and function in the treatment of chronic exertional compartment syndrome (CECS) of the forearm. […] In conclusion, compared to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications. […] The aetiology of chronic exertional compartment syndrome (CECS) remains debated. […] CECS of the lower limb is well reported; whereas CECS of the forearm is a rare condition in the general population, but can be observed in motorcycling racers, climbers, and rowers. […] CECS has been described to occur bilaterally in 70% to 100% of patients. […] Conservative treatment is effective but mainly consists of suspending the trigger activity, which is generally rejected by patients.

• #31 Lower Limb Exertional Compartment Syndrome | PM&R KnowledgeNow

  https://now.aapmr.org/lower-limb-exertional-compartment-syndrome/

  The United States military is considered a high-risk cohort with an adjusted annual incidence of up to 0.33-0.5 cases per 1000 person-years. […] Most recently, a large study has found equal prevalence of CECS in males and females, however, males were more likely to receive a diagnosis of CECS. […] In the pediatric population, one study has suggested that females are at highest risk of LLECS with a peak age incidence of 16 years-old. […] Chronic exertional compartment syndrome predominantly affects the lower leg, although CECS may also present in the upper extremity and rarely in the upper leg.

• #32 Chronic Exertional Compartment Syndrome in the Lower Limb – Sports Medicine Review

  https://www.sportsmedreview.com/blog/chronic-exertional-compartment-syndrome-of-the-lower-extremity/

  Chronic exertional compartment syndrome (CECS) is an uncommon presentation for the general population, but much more common in sports medicine. The incidence in the general population is unknown, but certain subpopulations of athletes have rates of 0.5 per 1,000 persons. Approximately 90-95 percent of cases involve the lower legs. It is also common to occur bilaterally (up to 82% of cases). There is no gender predilection and chronic exertional compartment syndrome sometimes occurs in conjunction with other diagnosis such as medial tibial stress syndrome, vascular insufficiency and nerve entrapment. The anterior compartment is most common, followed by the deep posterior, lateral and then superficial posterior compartments. […] Although debate exists in regards to etiology, the pathology is thought to arise from transient muscular ischemia and progressive neurovascular dysfunction due to the increased intramuscular pressures experienced during endurance. Normal muscle will hypertrophy with exertion but return to baseline within a few minutes; intracompartmental pressures follow a similar pattern. In documented cases of CECS, muscles expand up to 20% in volume against inelastic fascia and intracompartmental pressures rise in accordance with Laplace’s law. Resultant microvascular compromise and reduced venous return lead to ischemic pain, ultimately manifesting as workload intolerance and loss of function. Symptoms resolve completely between periods of activity and recur once the activity is resumed. Patients with lower-extremity CECS have higher intracompartmental pressures at rest as well as with exercise compared with normal individuals.

• #33 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  Chronic exertional compartment syndrome is typically considered a rare cause of lower extremity pain, with a reported incidence rate in active patients presenting with exercise-induced leg pain to be 33%. […] Waterman et al., in their retrospective study involving a military population, showed an average annual incidence of 0.49 per 1000 at-risk person-years. CECS is relatively common, especially among young adult athletes involved in running, endurance training, soccer, field hockey, and lacrosse. […] CECS predominantly affects the anterior compartment, representing up to 70% of cases in some series. Other reports cite the anterior and deep posterior compartments are the most frequently affected compartments (25% each), and simultaneous anterior and deep posterior involvement can happen in 8 to 10% of cases.

• #34

  https://www.orthobullets.com/knee-and-sports/3106/exertional-compartment-syndrome

  Exertional compartment syndrome is an exercise-induced condition of the extremity characterized by reversible ischemia to muscles within a muscular compartment. […] Epidemiology: Incidence: second most common exercise induced leg syndrome behind medial tibial stress syndrome. […] Demographics: males females, often seen in 3rd decade of life, runners or those who run a lot for their sport. […] Anatomic location: anterior leg compartment most commonly affected (~70%), anterior and lateral leg compartment affected in 10%. […] Posterior leg compartment involvement associated with less predictable surgical outcomes, more frequently associated with popliteal artery entrapment syndrome (PAES). […] Most common cause is the presence of an accessory head of the medial gastrocnemius muscle. […] Volar forearm less commonly encountered, but occurs in sports requiring repetitive gripping. […] Volar forearm compartment most commonly affected.

• #35 Exertional Compartment Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544284/

  Chronic exertional compartment syndrome is typically considered a rare cause of lower extremity pain, with a reported incidence rate in active patients presenting with exercise-induced leg pain to be 33%. […] Waterman et al., in their retrospective study involving a military population, showed an average annual incidence of 0.49 per 1000 at-risk person-years. CECS is relatively common, especially among young adult athletes involved in running, endurance training, soccer, field hockey, and lacrosse. […] CECS predominantly affects the anterior compartment, representing up to 70% of cases in some series. Other reports cite the anterior and deep posterior compartments are the most frequently affected compartments (25% each), and simultaneous anterior and deep posterior involvement can happen in 8 to 10% of cases.

• #36

  https://www.orthobullets.com/knee-and-sports/3106/exertional-compartment-syndrome

  Exertional compartment syndrome is an exercise-induced condition of the extremity characterized by reversible ischemia to muscles within a muscular compartment. […] Epidemiology: Incidence: second most common exercise induced leg syndrome behind medial tibial stress syndrome. […] Demographics: males females, often seen in 3rd decade of life, runners or those who run a lot for their sport. […] Anatomic location: anterior leg compartment most commonly affected (~70%), anterior and lateral leg compartment affected in 10%. […] Posterior leg compartment involvement associated with less predictable surgical outcomes, more frequently associated with popliteal artery entrapment syndrome (PAES). […] Most common cause is the presence of an accessory head of the medial gastrocnemius muscle. […] Volar forearm less commonly encountered, but occurs in sports requiring repetitive gripping. […] Volar forearm compartment most commonly affected.

• #37

  https://www.orthobullets.com/knee-and-sports/3106/exertional-compartment-syndrome

  Exertional compartment syndrome is an exercise-induced condition of the extremity characterized by reversible ischemia to muscles within a muscular compartment. […] Epidemiology: Incidence: second most common exercise induced leg syndrome behind medial tibial stress syndrome. […] Demographics: males females, often seen in 3rd decade of life, runners or those who run a lot for their sport. […] Anatomic location: anterior leg compartment most commonly affected (~70%), anterior and lateral leg compartment affected in 10%. […] Posterior leg compartment involvement associated with less predictable surgical outcomes, more frequently associated with popliteal artery entrapment syndrome (PAES). […] Most common cause is the presence of an accessory head of the medial gastrocnemius muscle. […] Volar forearm less commonly encountered, but occurs in sports requiring repetitive gripping. […] Volar forearm compartment most commonly affected.

• #38 Demographic Characteristics Among Patients With Chronic Exertional Compartment Syndrome of the Lower Leg in: Journal of Sport Rehabilitation Volume 29 Issue 8 (2020)

  https://journals.humankinetics.com/view/journals/jsr/29/8/article-p1214.xml

  Chronic exertional compartment syndrome (CECS) is a condition related with ischemia of the bodys tissue due to increases in intracompartmental pressures, which involves, among other symptoms, pain with exertion. CECS is often overlooked or misdiagnosed due to an ambiguous presentation. […] Research is lacking on the type of patient most likely to experience CECS, highlighting the need for identification of common demographic characteristics among affected individuals. […] Current evidence has identified commonalities in sex, age, and sport participation as characteristics often present among individuals experiencing lower leg CECS. […] There is level B evidence in support of certain sex, age, and sport participation demographics as common characteristics among those experiencing CECS of the lower leg.

• #39 Chronic exertional compartment syndrome: current management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6537460/

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. […] Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. […] Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. […] There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. […] Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

• #40 Chronic exertional compartment syndrome: current management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6537460/

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. […] Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. […] Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. […] There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. […] Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

• #41 Chronic exertional compartment syndrome | The BMJ

  https://www.bmj.com/content/346/bmj.f33/rapid-responses

  We read a well written article by Paik et al on CECS with interest and make the following comments: […] CECS also occurs in the forearm (usually the superficial and deep flexor compartments) and the foot (usually the medial and central compartments). […] Measurement of Intra-compartment pressure is a primary investigation to support the diagnosis of CECS. […] The system used must also be versatile enough to allow measurement of ICP in patients specific exercise which provokes the symptoms as in some cases increase in ICP is exercise specific. […] CECS affecting the deep posterior compartment is often associated with Medial Tibial Stress Syndrome. […] I agree with earlier responses and the authors own reference to Aweid et al. recent work questioning the reliability of intracompartmental pressure testing.

• #42

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #43

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #44

  https://journals.lww.com/acsm-csmr/fulltext/2023/06000/the_pressure_is_rising__evaluation_and_treatment.6.aspx

  The current standard for detecting CECS is ICP testing using a pressure gauge needle. This involves inserting the needle into the compartment of interest before any exercise/exertion, as well as at 1 min, and at 5 min postexercise, while also monitoring for the reproduction of symptoms. […] Nonoperative treatment protocols remain the first line of interventions over 3 to 6 months given the inconsistent success rate, recovery time, and return to activity rate of surgical intervention. There is limited head-to-head data for nonsurgical versus surgical interventions. For those attempting to return to various athletics or military services, data suggests that surgical intervention may have a slightly lower rate of symptom reduction. However, there is inconclusive data regarding rate of return to previous level of sport.

• #45 Chronic Exertional Compartment Syndrome in the Lower Limb – Sports Medicine Review

  https://www.sportsmedreview.com/blog/chronic-exertional-compartment-syndrome-of-the-lower-extremity/

  The patient’s clinical history is the most important factor for diagnosis. Thorough static and dynamic physical examination aids in eliminating other etiologies. Intracompartmental pressure measurements before, during, and after exercising are standard for the diagnosis of CECS of the lower extremity. The diagnostic criteria for CECS in the lower extremity published by Pedowitz et al include resting pressure greater than 15 mm Hg, pressure one minute after exercise > 30 mm Hg, and/or pressure 5 minutes after exercise greater 20 mm Hg. These criteria have been used for over two decades, although controversy remains about the role and validity of this criteria. […] In summary, chronic exertional compartment syndrome of the lower extremity is uncommon in the general population but is a common diagnosis for athletes complaining of claudication symptoms. A thorough history is imperative for diagnosis and providers must have suspicion in certain populations. Diagnosis is usually done by manometry of the lower extremity compartments before and after exercising or provocative maneuvers. It is also very important to be aware that CECS occurs in conjunction with other conditions and these may need to be ruled out. Most begin with non operative measures and a forefoot running program and Botox have shown promise in limited studies. Fasciotomy is the more definitive treatment and results are generally favorable. More studies are needed to more definitively treat and diagnose CECS.

• #46 Chronic Exertional Compartment Syndrome in the Lower Limb – Sports Medicine Review

  https://www.sportsmedreview.com/blog/chronic-exertional-compartment-syndrome-of-the-lower-extremity/

  The patient’s clinical history is the most important factor for diagnosis. Thorough static and dynamic physical examination aids in eliminating other etiologies. Intracompartmental pressure measurements before, during, and after exercising are standard for the diagnosis of CECS of the lower extremity. The diagnostic criteria for CECS in the lower extremity published by Pedowitz et al include resting pressure greater than 15 mm Hg, pressure one minute after exercise > 30 mm Hg, and/or pressure 5 minutes after exercise greater 20 mm Hg. These criteria have been used for over two decades, although controversy remains about the role and validity of this criteria. […] In summary, chronic exertional compartment syndrome of the lower extremity is uncommon in the general population but is a common diagnosis for athletes complaining of claudication symptoms. A thorough history is imperative for diagnosis and providers must have suspicion in certain populations. Diagnosis is usually done by manometry of the lower extremity compartments before and after exercising or provocative maneuvers. It is also very important to be aware that CECS occurs in conjunction with other conditions and these may need to be ruled out. Most begin with non operative measures and a forefoot running program and Botox have shown promise in limited studies. Fasciotomy is the more definitive treatment and results are generally favorable. More studies are needed to more definitively treat and diagnose CECS.

• #47 Compartment Syndrome Diagnosis | Millar Clinical Applications

  https://millar.com/Clinical/Clinical-Applications/Compartment-Syndrome-Diagnosis/

  Mikro-Cath high-fidelity pressure measurements provide orthopedic trauma surgeons with reliable, accurate pressure signals to support and simplify compartment syndrome diagnoses for trauma patients. […] Continuous pressure monitoring during exercise studies supports sports medicine physicians diagnose chronic exertional compartment syndrome due to the sensor’s solid-state pressure stability. […] The Millar Mikro-Cath Pressure Catheter has been used to assess chronic exertional compartment syndrome. Studies have demonstrated that these sensors work well to measure compartment pressure while subjects are supine as well as during treadmill exercise with a military backpack.

• #48 Intracompartmental Pressures | Millar Clinical Applications

  https://millar.com/Clinical/Clinical-Applications/Intracompartmental-Pressures/

  The Mikro-Cath is a viable alternative to the previous Stryker compartment pressure monitor (now C2DX STIC intra-compartmental pressure monitor) and provides the advantage of continuous pressure monitoring, reliable signals, and ease of use. […] The Mikro-Cath offers improved sensitivity and specificity over existing methods in the diagnosis of anterior compartment CECS by obtaining continuous, high fidelity data. […] Discover how Dr. Jaap Stomphorst revolutionized Chronic Exertional Compartment Syndrome (CECS) testing using Millars Mikro-Cath. With over 300 patients tested, his success story showcases how real-time, continuous pressure monitoring enhances diagnostic accuracy and improves patient outcomes. […] Discover how innovative catheter-based devices are changing the game in diagnosing Chronic Exertional Compartment Syndrome.

• #49

  https://link.springer.com/article/10.1007/s40141-018-0184-y

  The goal of this paper is to review the current evidence on diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg. […] Research has shown promising outcomes with non-operative management including targeted alterations to running biomechanics. […] Innovations in the diagnosis of CECS include the use of continuous compartment pressure monitoring during exercise as well as some early research on the use of musculoskeletal ultrasound and particular MRI protocols of the lower leg. […] Future research is needed on alternative diagnostic modalities including musculoskeletal ultrasound and exercise MRI protocols and on alternative management strategies including botulinum toxin injection and ultrasound-guided fascial fenestration or fasciotomy. […] Significantly lower intramuscular pressure in the posterior and lateral compartments compared with the anterior compartment suggests alterations of the diagnostic criteria for chronic exertional compartment syndrome in the lower leg.

• #50 SciELO Brazil – The Role of Magnetic Resonance in the Diagnosis of Chronic Exertional Compartment Syndrome The Role of Magnetic Resonance in the Diagnosis of Chronic Exertional Compartment Syndrome

  https://www.scielo.br/j/rbort/a/MNFDz7p3k8RcbygDzvSsYqm/

  Chronic compartment syndrome is a common and often underdiagnosed exercise-induced condition, accounting on average for a quarter of cases of chronic exertional pain in the leg, second only to the fracture/tibial stress syndrome spectrum. […] Chronic exertional compartment syndrome (CECS) is a common and often underdiagnosed entity, which accounts for about 10% to 60% (mean of 1/4) of exercise-related leg pain, and is responsible for about 14% to 27% of cases with no definite diagnosis of leg pain, second only to spectrum fracture/tibial stress syndrome. […] The diagnosis of CECS is by common exclusion, and it is underdiagnosed in the context of exercise-related leg pain. Although needle manometry is still the gold-standard method in the medical literature, the needle equipment is rarely available in Brazil, the method has several limitations, and it is, thus, questioned by some authors. Protocol-specific MRI, including postexercise sequences, is an excellent noninvasive option for needle manometry in the diagnosis of chronic exertional compartment syndrome, as well as the best option to rule out differential diagnoses.

• #51 Chronic Exertional Compartment Syndrome | Foot and Ankle | Orthopedic Services | University Hospitals | Cleveland, OH | University Hospitals

  https://www.uhhospitals.org/services/orthopedic-services/conditions-and-treatments/foot-and-ankle-services/chronic-exertional-compartment-syndrome

  Chronic exertional compartment syndrome (CECS) is a condition that causes pain and swelling in one or more of these muscle groups during exercise or exertion. It most commonly occurs in the lower legs. […] CECS can occur at any age but is most common in endurance athletes under the age of 30. […] If CECS is suspected, your doctor may order imaging tests, including: MRI to evaluate the structure of the affected muscles and measure fluid volumes. […] A surgical procedure called fasciotomy is the most effective and lasting treatment for CECS.

• #52 Chronic exertional compartment syndrome | The BMJ

  https://www.bmj.com/content/346/bmj.f33/rapid-responses

  A recent systematic review by Aweid O et al. states that levels above 27.5 mm Hg at 1 min post exercise along with a good history should be regarded as highly suggestive of CECS. […] The general teaching that invasive compartment pressure monitoring is GOLD STANDARD in diagnosing the CECS may not be totally true. […] A survey done in UK, however, showed that most (83%) of the orthopaedic surgeons and sports medicine specialists still use compartment pressure monitoring for the diagnosis of CECS.

• #53 Chronic exertional compartment syndrome | The BMJ

  https://www.bmj.com/content/346/bmj.f33/rapid-responses

  A recent systematic review by Aweid O et al. states that levels above 27.5 mm Hg at 1 min post exercise along with a good history should be regarded as highly suggestive of CECS. […] The general teaching that invasive compartment pressure monitoring is GOLD STANDARD in diagnosing the CECS may not be totally true. […] A survey done in UK, however, showed that most (83%) of the orthopaedic surgeons and sports medicine specialists still use compartment pressure monitoring for the diagnosis of CECS.

• #54

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of chronic exertional compartment syndrome (CECS) is hampered by the absence of high-quality scientific research. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS of the leg in civilian and military patient populations. […] The panel achieved partial agreement regarding standardization of the diagnostic protocol, including muscle tissue pressure measurements. […] Consensus was reached on conservative and surgical treatment regimens. […] The Delphi panel reached consensus on key criteria for signs and symptoms of CECS and several aspects for conservative and surgical treatment. […] The panel did not agree on the role of ICP values in the diagnostic process, postoperative rehabilitation guidelines protocol, or the preferred treatment approach for recurrent or residual disease.

• #55

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #56

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of chronic exertional compartment syndrome (CECS) is hampered by the absence of high-quality scientific research. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS of the leg in civilian and military patient populations. […] The panel achieved partial agreement regarding standardization of the diagnostic protocol, including muscle tissue pressure measurements. […] Consensus was reached on conservative and surgical treatment regimens. […] The Delphi panel reached consensus on key criteria for signs and symptoms of CECS and several aspects for conservative and surgical treatment. […] The panel did not agree on the role of ICP values in the diagnostic process, postoperative rehabilitation guidelines protocol, or the preferred treatment approach for recurrent or residual disease.

• #57

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #58

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #59

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #60

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  Defining universally accepted guidelines for the diagnosis and treatment of CECS of the leg appears to be hampered by the absence of robust empirical evidence. […] The aim of this Delphi study was to establish consensus on practical issues guiding diagnosis and treatment of CECS in civilian and military patient populations. […] The panel agreed that an ICP measurement is conditional for the diagnosis. […] The panel did not achieve consensus with respect to leg and patient positioning. […] The majority of panel members either used the Pedowitz criteria or part of these. […] The panel considered symptom provocation by use of a treadmill test and repeat physical examination a conditional test for the diagnosis. […] Panel members reached consensus that signs and symptoms are the essential aspects of the diagnostic work-up.

• #61 Chronic exertional compartment syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-exertional-compartment-syndrome/symptoms-causes/syc-20350830

  Repetitive impact activity such as running increases your risk of developing the condition. […] Working out too intensely or too frequently also can raise your risk of chronic exertional compartment syndrome. […] Chronic exertional compartment syndrome isn’t a life-threatening condition and usually doesn’t cause lasting damage if you get appropriate treatment.

• #62 Chronic exertional compartment syndrome | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/chronic-exertional-compartment-syndrome?content_id=CON-20155275

  Chronic exertional compartment syndrome isn’t a life-threatening condition and usually doesn’t cause lasting damage if you get appropriate treatment. However, pain, weakness or numbness associated with chronic exertional compartment syndrome may prevent you from continuing to exercise or practice your sport at the same level of intensity. […] Other exercise-related problems are more common than chronic exertional compartment syndrome, so your doctor may first try to rule out other causes such as shin splints or stress fractures before moving on to more specialized testing. […] Options to treat chronic exertional compartment syndrome include both nonsurgical and surgical methods. However, nonsurgical measures are typically successful only if you stop or greatly reduce the activity that caused the condition. […] A surgical procedure called fasciotomy is the most effective treatment of chronic exertional compartment syndrome. It involves cutting open the inflexible tissue encasing each of the affected muscle compartments. This relieves the pressure.

• #63 Chronic exertional compartment syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/chronic-exertional-compartment-syndrome

  Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. Anyone can develop the condition, but it’s more common in young adult runners and athletes who participate in activities that involve repetitive impact. […] Certain factors increase your risk of developing chronic exertional compartment syndrome, including: Age. Although people of any age can develop chronic exertional compartment syndrome, the condition is most common in male and female athletes under age 30. […] Chronic exertional compartment syndrome isn’t a life-threatening condition and usually doesn’t cause lasting damage if you get appropriate treatment. However, pain, weakness or numbness associated with chronic exertional compartment syndrome may prevent you from continuing to exercise or practice your sport at the same level of intensity.

• #64 Compartment syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Compartment_syndrome

  Chronic compartment syndrome (CCS), or chronic exertional compartment syndrome, causes pain with exercise. The pain fades after activity stops. Other symptoms may include numbness. Symptoms usually resolve with rest. Running and biking commonly trigger CCS. This condition generally does not cause permanent damage. […] A subset of chronic compartment syndrome is chronic exertional compartment syndrome (CECS), often called exercise-induced compartment syndrome. CECS is often a diagnosis of exclusion. CECS of the leg is caused by exercise. This condition occurs commonly in the lower leg and various other locations within the body, such as the foot or forearm. CECS can be seen in athletes who train rigorously in activities that involve constant repetitive actions or motions. […] Chronic exertional compartment syndrome can be treated by reducing or stopping exercise and other activities; massage; non-steroidal anti-inflammatory medication; and physiotherapy. If symptoms persist after basic treatment, compartment syndrome may be treated with a fasciotomy.

• #65

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  The panel agreed that gait retraining and cessation of provoking activities are valuable components of a conservative treatment program. […] The panel agreed on the statement that a standardized institutional rehabilitation protocol should be used postoperatively. […] No consensus was achieved on management of recurrent or residual disease after surgical treatment. […] This three-round Delphi analysis established consensus on several aspects regarding the clinical practice guidelines for diagnosis and treatment of lower leg CECS in both civilian and military patient populations. […] The outcome of this Delphi analysis on CECS may serve as a platform to initiate simple guidelines for clinical practice.

• #66

  https://journals.lww.com/acsm-csmr/fulltext/2023/06000/the_pressure_is_rising__evaluation_and_treatment.6.aspx

  The current standard for detecting CECS is ICP testing using a pressure gauge needle. This involves inserting the needle into the compartment of interest before any exercise/exertion, as well as at 1 min, and at 5 min postexercise, while also monitoring for the reproduction of symptoms. […] Nonoperative treatment protocols remain the first line of interventions over 3 to 6 months given the inconsistent success rate, recovery time, and return to activity rate of surgical intervention. There is limited head-to-head data for nonsurgical versus surgical interventions. For those attempting to return to various athletics or military services, data suggests that surgical intervention may have a slightly lower rate of symptom reduction. However, there is inconclusive data regarding rate of return to previous level of sport.

• #67

  https://link.springer.com/article/10.1007/s40141-018-0184-y

  The goal of this paper is to review the current evidence on diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg. […] Research has shown promising outcomes with non-operative management including targeted alterations to running biomechanics. […] Innovations in the diagnosis of CECS include the use of continuous compartment pressure monitoring during exercise as well as some early research on the use of musculoskeletal ultrasound and particular MRI protocols of the lower leg. […] Future research is needed on alternative diagnostic modalities including musculoskeletal ultrasound and exercise MRI protocols and on alternative management strategies including botulinum toxin injection and ultrasound-guided fascial fenestration or fasciotomy. […] Significantly lower intramuscular pressure in the posterior and lateral compartments compared with the anterior compartment suggests alterations of the diagnostic criteria for chronic exertional compartment syndrome in the lower leg.

• #68 Chronic exertional compartment syndrome | The BMJ

  https://www.bmj.com/content/346/bmj.f33/rapid-responses

  Furthermore, unfortunately outcomes of conservative management are rarely acceptable and whilst surgical intervention can produce satisfactory results, at least in the short-term, it is not without potential complication. […] Such a gait is often adapted by barefoot runners, which has attracted much recent attention following Lieberman et al. studies in habitually barefoot individuals. […] Work by Diebel et al. found significant improvements in intracompartmental pressure, running distance and pain following a 6-week intervention involving instruction and training to adopt a forefoot strike pattern in 10 patients diagnosed with chronic exertional compartment syndrome (CECS) with significant subjective and objective improvements remaining at 1-year follow-up. […] While the clinical example in the article referred to a 'runner’, this syndrome can occur on the exertion of walking in non-diabetics and I have recently seen a case remain undiagnosed after the opinion of an orthopaedic surgeon, a neurologist, a vascular surgeon and a rheumatologist.

• #69 Our knowledge of orthopaedics. Your best health.

  https://orthoinfo.aaos.org/en/diseases–conditions/compartment-syndrome/

  Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. […] Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion and is reversible with rest. […] The pain and swelling of chronic compartment syndrome is caused by exercise. People who participate in activities with repetitive motions, such as running or marching, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous. […] To confirm chronic compartment syndrome, your doctor will measure the pressures in your compartment before and after exercise. If pressures remain high after exercise, you have chronic compartment syndrome. […] Surgery for chronic exertional compartment syndrome of the leg produces excellent results in the anterior and lateral compartments, and less predictable results when the posterior compartments are involved. An accurate diagnosis is key to achieving a significant benefit from surgery.

• #70 Chronic exertional compartment syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/chronic-exertional-compartment-syndrome

  Other exercise-related problems are more common than chronic exertional compartment syndrome, so your doctor may first try to rule out other causes such as shin splints or stress fractures before moving on to more specialized testing. […] Options to treat chronic exertional compartment syndrome include both nonsurgical and surgical methods. However, nonsurgical measures are typically successful only if you stop or greatly reduce the activity that caused the condition. […] A surgical procedure called fasciotomy is the most effective treatment of chronic exertional compartment syndrome. It involves cutting open the inflexible tissue encasing each of the affected muscle compartments. This relieves the pressure.

• #71 Chronic exertional compartment syndrome | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/chronic-exertional-compartment-syndrome

  Other exercise-related problems are more common than chronic exertional compartment syndrome, so your doctor may first try to rule out other causes such as shin splints or stress fractures before moving on to more specialized testing. […] Options to treat chronic exertional compartment syndrome include both nonsurgical and surgical methods. However, nonsurgical measures are typically successful only if you stop or greatly reduce the activity that caused the condition. […] A surgical procedure called fasciotomy is the most effective treatment of chronic exertional compartment syndrome. It involves cutting open the inflexible tissue encasing each of the affected muscle compartments. This relieves the pressure.

• #72 Chronic exertional compartment syndrome: current management strategies | OAJSM

  https://www.dovepress.com/chronic-exertional-compartment-syndrome-current-management-strategies-peer-reviewed-fulltext-article-OAJSM

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. […] Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. […] Nonoperative management has a limited role in the treatment of CECS, but hindfoot runners may benefit from forefoot running training. […] Fasciotomy is the preferred operative treatment for both lower-extremity and upper-extremity CECS. Good results have been reported after open, single-incision, minimally invasive, percutaneous, endoscopic, and ultrasound-guided techniques.

• #73 Chronic exertional compartment syndrome: current management strategies | OAJSM

  https://www.dovepress.com/chronic-exertional-compartment-syndrome-current-management-strategies-peer-reviewed-fulltext-article-OAJSM

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. […] Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. […] Nonoperative management has a limited role in the treatment of CECS, but hindfoot runners may benefit from forefoot running training. […] Fasciotomy is the preferred operative treatment for both lower-extremity and upper-extremity CECS. Good results have been reported after open, single-incision, minimally invasive, percutaneous, endoscopic, and ultrasound-guided techniques.

• #74 Chronic exertional compartment syndrome: current management strategies | OAJSM

  https://www.dovepress.com/chronic-exertional-compartment-syndrome-current-management-strategies-peer-reviewed-fulltext-article-OAJSM

  Improved surgical outcomes are seen in younger patients and those who undergo fasciotomies of all compartments. […] There is limited literature on postsurgical rehabilitation protocols after fasciotomies for CECS in the upper and lower extremities and in the adult versus pediatric population. […] Further research also needs to be done to understand why a large portion (~20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

• #75 Our knowledge of orthopaedics. Your best health.

  https://orthoinfo.aaos.org/en/diseases–conditions/compartment-syndrome/

  Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. […] Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion and is reversible with rest. […] The pain and swelling of chronic compartment syndrome is caused by exercise. People who participate in activities with repetitive motions, such as running or marching, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous. […] To confirm chronic compartment syndrome, your doctor will measure the pressures in your compartment before and after exercise. If pressures remain high after exercise, you have chronic compartment syndrome. […] Surgery for chronic exertional compartment syndrome of the leg produces excellent results in the anterior and lateral compartments, and less predictable results when the posterior compartments are involved. An accurate diagnosis is key to achieving a significant benefit from surgery.

• #76 Chronic Exertional Compartment Syndrome | Treatment & Surgery Options

  https://www.sportsmd.com/sports-injuries/hip-thigh-injuries/chronic-exertional-compartment-syndrome/

  A direct measure of pressures can be performed after the onset of symptoms with a special pressure monitor. […] Nonoperative management of athletes with CECS always includes activity modification and essentially giving up aggravating activity or sport. […] Presently there are no medical remedies available to treat CECS. […] Most common complications of the surgical fasciotomy procedures include an insufficient release with recurrence of symptoms reported in up to 17% of patients. […] Despite these reported complications, a well-done operation can yield 80-100% successful resolution of symptoms in athletes.

• #77 Chronic Exertional Compartment Syndrome | Treatment & Surgery Options

  https://www.sportsmd.com/sports-injuries/hip-thigh-injuries/chronic-exertional-compartment-syndrome/

  A direct measure of pressures can be performed after the onset of symptoms with a special pressure monitor. […] Nonoperative management of athletes with CECS always includes activity modification and essentially giving up aggravating activity or sport. […] Presently there are no medical remedies available to treat CECS. […] Most common complications of the surgical fasciotomy procedures include an insufficient release with recurrence of symptoms reported in up to 17% of patients. […] Despite these reported complications, a well-done operation can yield 80-100% successful resolution of symptoms in athletes.

• #78 Registry Development and Non-Surgical Treatment Options for Chronic Exertional Compartment Syndrome — MIRROR | Musculoskeletal Injury Rehabilitation Research for Operational Readiness

  https://mirrorusuhs.org/mirror-projects/project5

  Chronic exertional compartment syndrome (CECS) is a debilitating disorder affecting mostly an active population. CECS involves the lower extremities, primarily affects young active adults, and limits running and/or endurance activities. While the incidence of CECS in the general population is unknown, the prevalence in the military population has been found to be 0.49 cases per 1000 patient-years. […] The current standard for definitive treatment of CECS is surgical fasciotomy of the involved compartments. According to a 2016 systematic review, surgical intervention for CECS is successful in only 66% of those affected, with 13% of patients reporting complications from surgery, and 6% needing a repeat procedure. A 2014 retrospective review of military members showed that only 59% of patients who underwent elective fasciotomy for CECS were able to return to full duty while 22% of the patients that were treated with fasciotomy were eventually medically discharged.

• #79 Registry Development and Non-Surgical Treatment Options for Chronic Exertional Compartment Syndrome — MIRROR | Musculoskeletal Injury Rehabilitation Research for Operational Readiness

  https://mirrorusuhs.org/mirror-projects/project5

  Chronic exertional compartment syndrome (CECS) is a debilitating disorder affecting mostly an active population. CECS involves the lower extremities, primarily affects young active adults, and limits running and/or endurance activities. While the incidence of CECS in the general population is unknown, the prevalence in the military population has been found to be 0.49 cases per 1000 patient-years. […] The current standard for definitive treatment of CECS is surgical fasciotomy of the involved compartments. According to a 2016 systematic review, surgical intervention for CECS is successful in only 66% of those affected, with 13% of patients reporting complications from surgery, and 6% needing a repeat procedure. A 2014 retrospective review of military members showed that only 59% of patients who underwent elective fasciotomy for CECS were able to return to full duty while 22% of the patients that were treated with fasciotomy were eventually medically discharged.

• #80 Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies | Scientific Reports

  https://www.nature.com/articles/s41598-021-03825-4

  Chronic exertional compartment syndrome (CECS) is a condition occurring most frequently in the lower limbs and often requires corrective surgery to alleviate symptoms. Amongst military personnel, the success rates of this surgery can be as low as 20%, presenting a challenge in determining whether surgery is worthwhile. […] Surgical interventions in the form of compartment-specific fasciotomies have become a prominent method of treating CECS. […] Audits suggest that less than 45% of UK military personnel manage to return to a fully-fit state, with most recent evidence showing this number to be as low as 22%. […] Despite the problem of poor outcomes in military populations, only one study, to date, has sought to identify reasons as to why patients fail to have good surgical outcomes. […] The application of machine learning within orthopaedic medicine is a growing area, showing promise in treatment outcome prediction.

• #81 Registry Development and Non-Surgical Treatment Options for Chronic Exertional Compartment Syndrome — MIRROR | Musculoskeletal Injury Rehabilitation Research for Operational Readiness

  https://mirrorusuhs.org/mirror-projects/project5

  Military sports medicine clinics at Fort Belvoir Community Hospital (FBCH) and USU have been utilizing BoNT-A injections for the non-surgical treatment of CECS. A retrospective review of patients with CECS treated with BoNT-A at FBCH Sports Medicine Clinic from 2014 to 2017 provided data on twenty-nine patients who were treated with BoNT-A for CECS. […] The purpose of this grant application is to create a registry across all MTFs for CECS to compare diagnostic and therapeutic data. We will simultaneously assess the effectiveness of non-surgical treatments options for chronic exertional compartment syndrome as well as test the use of xylocaine injections to predict success for non-surgical or surgical options at selected sites.

• #82 Chronic exertional compartment syndrome: current management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6537460/

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. […] Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. […] Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. […] There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. […] Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

• #83 Chronic exertional compartment syndrome: current management strategies | OAJSM

  https://www.dovepress.com/chronic-exertional-compartment-syndrome-current-management-strategies-peer-reviewed-fulltext-article-OAJSM

  Improved surgical outcomes are seen in younger patients and those who undergo fasciotomies of all compartments. […] There is limited literature on postsurgical rehabilitation protocols after fasciotomies for CECS in the upper and lower extremities and in the adult versus pediatric population. […] Further research also needs to be done to understand why a large portion (~20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

• #84 Chronic exertional compartment syndrome: current management strategies | OAJSM

  https://www.dovepress.com/chronic-exertional-compartment-syndrome-current-management-strategies-peer-reviewed-fulltext-article-OAJSM

  Improved surgical outcomes are seen in younger patients and those who undergo fasciotomies of all compartments. […] There is limited literature on postsurgical rehabilitation protocols after fasciotomies for CECS in the upper and lower extremities and in the adult versus pediatric population. […] Further research also needs to be done to understand why a large portion (~20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

• #85 Diagnosis of chronic exertional compartment syndrome in primary care | British Journal of General Practice

  https://bjgp.org/content/65/637/e560

  Chronic exertional compartment syndrome (CECS) is a disorder that typically presents as bilateral lower leg pain during exercise but is absent at rest. This is due to compression of a fascial compartment causing pain during exercise. It commonly presents in primary care but is often under-diagnosed due to a lack of awareness of the ailment by both patients and practitioners. If left undiagnosed it can lead to ischaemia and then infarction of the affected muscle compartment. […] CECS is often overlooked as a cause of muscle pain and there can be as much as a 22-month delay in the diagnosis of the condition. It has a widely varying incidence, which has been reported to be between 10-64%. This is because CECS can present with many different symptoms and can therefore be easily misdiagnosed. Patients often only seek medical attention at a late stage, as they believe it to be a less serious disorder. Classically it presents as a burning, aching, or bursting pain in both legs, which occurs only during exercise and completely ceases at rest. The symptoms are more likely to be bilateral with figures between 70-90% quoted in various studies. The anterior compartment is most commonly affected. GPs should examine the patient both before and after exertion to demonstrate a normal physical examination pre-exercise and a possible bulge in the affected compartment together with pain on palpation and possible neurovascular compromise in the affected area post-exercise. CECS is prevalent equally in both sexes with a median age of onset of 20-years-old and is associated with diabetes mellitus.

• #86 Diagnosis of chronic exertional compartment syndrome in primary care | British Journal of General Practice

  https://bjgp.org/content/65/637/e560

  Most cases of CECS initially present in primary care, at a later stage of disease progression, as individuals believe the absence of symptoms at rest indicates a less serious and self-manageable disorder. The non-specific term shin splints is often used by patients to cover a wide range of leg symptoms; which may sidetrack the GP from correctly diagnosing the disorder. It is therefore paramount that the physician sufficiently probes while taking a history. Moreover the absence of symptoms on examination at rest and negative findings on scans and X-rays, which are classically found in CECS, may distract the physician from making a prompt diagnosis and therefore further delay management. Indeed, apart from intracompartmental pressure measurement, other investigations are not cost effective, can take a significant amount of time to actually perform, and can therefore be more of a hindrance than a help. Increased education and knowledge of CECS is needed by GPs to allow early diagnosis, suitable investigation and appropriate management.

• #87 Diagnosis of chronic exertional compartment syndrome in primary care | British Journal of General Practice

  https://bjgp.org/content/65/637/e560

  Most cases of CECS initially present in primary care, at a later stage of disease progression, as individuals believe the absence of symptoms at rest indicates a less serious and self-manageable disorder. The non-specific term shin splints is often used by patients to cover a wide range of leg symptoms; which may sidetrack the GP from correctly diagnosing the disorder. It is therefore paramount that the physician sufficiently probes while taking a history. Moreover the absence of symptoms on examination at rest and negative findings on scans and X-rays, which are classically found in CECS, may distract the physician from making a prompt diagnosis and therefore further delay management. Indeed, apart from intracompartmental pressure measurement, other investigations are not cost effective, can take a significant amount of time to actually perform, and can therefore be more of a hindrance than a help. Increased education and knowledge of CECS is needed by GPs to allow early diagnosis, suitable investigation and appropriate management.

• #88 Chronic Exertional Compartment Syndrome: An Underdiagnosed Condition?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na53707/2021/06/08/chronic-exertional-compartment-syndrome-underdiagnosed

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition. […] In chronic exertional compartment syndrome (CECS), physical activity induces pain — usually in the lower leg. […] The diagnosis is typically made in relatively young athletes, but CECS also develops occasionally in older adults. […] Because CECS symptoms overlap with those of peripheral arterial disease (PAD), researchers at a Netherlands referral center compared characteristics of 43 CECS patients (age, ≥50; range, 50–76) and 41 patients with intermittent claudication caused by documented PAD. […] CECS was confirmed by direct intracompartmental pressure measurements in the lower leg performed when pain was provoked during exercise on a treadmill. […] Some experts believe that CECS is overlooked in older people because many clinicians are unfamiliar with it; that probably applies to me, as I’ve never made this diagnosis. […] We should keep CECS in mind when middle-aged and older patients present with intermittent claudication that is not explained by a vascular or neurogenic cause.

• #89 Chronic exertional compartment syndrome prevalent in the military population | 2 Minute Medicine

  https://www.2minutemedicine.com/chronic-exertional-compartment-syndrome-prevalent-in-the-military-population/

  1. Chronic exertional compartment syndrome is common in the military population. […] Treatment with elective fasciotomy of the leg leads to high rates of symptom recurrence, surgical complications, and disability-associated military discharge. […] Chronic exertional compartment syndrome is an important source of disability for military personnel, as well as high level athletes. […] This study represents the largest known cohort with chronic exertional compartment syndrome of the leg, and provides valuable information on the outcomes after elective fasciotomy in a physically active patient population. […] Symptoms recurred after the fasciotomy in 44.7% of the patients, and 27.8% of the patients were unable to return to full activity. […] Complications occurred in 15.7% of patients, usually involving wound infection, neurological complication, or wound dehiscence.

• #90 Chronic exertional compartment syndrome prevalent in the military population | 2 Minute Medicine

  https://www.2minutemedicine.com/chronic-exertional-compartment-syndrome-prevalent-in-the-military-population/

  1. Chronic exertional compartment syndrome is common in the military population. […] Treatment with elective fasciotomy of the leg leads to high rates of symptom recurrence, surgical complications, and disability-associated military discharge. […] Chronic exertional compartment syndrome is an important source of disability for military personnel, as well as high level athletes. […] This study represents the largest known cohort with chronic exertional compartment syndrome of the leg, and provides valuable information on the outcomes after elective fasciotomy in a physically active patient population. […] Symptoms recurred after the fasciotomy in 44.7% of the patients, and 27.8% of the patients were unable to return to full activity. […] Complications occurred in 15.7% of patients, usually involving wound infection, neurological complication, or wound dehiscence.

• #91 Chronic exertional compartment syndrome prevalent in the military population | 2 Minute Medicine

  https://www.2minutemedicine.com/chronic-exertional-compartment-syndrome-prevalent-in-the-military-population/

  1. Chronic exertional compartment syndrome is common in the military population. […] Treatment with elective fasciotomy of the leg leads to high rates of symptom recurrence, surgical complications, and disability-associated military discharge. […] Chronic exertional compartment syndrome is an important source of disability for military personnel, as well as high level athletes. […] This study represents the largest known cohort with chronic exertional compartment syndrome of the leg, and provides valuable information on the outcomes after elective fasciotomy in a physically active patient population. […] Symptoms recurred after the fasciotomy in 44.7% of the patients, and 27.8% of the patients were unable to return to full activity. […] Complications occurred in 15.7% of patients, usually involving wound infection, neurological complication, or wound dehiscence.

• #92 Chronic exertional compartment syndrome prevalent in the military population | 2 Minute Medicine

  https://www.2minutemedicine.com/chronic-exertional-compartment-syndrome-prevalent-in-the-military-population/

  1. Chronic exertional compartment syndrome is common in the military population. […] Treatment with elective fasciotomy of the leg leads to high rates of symptom recurrence, surgical complications, and disability-associated military discharge. […] Chronic exertional compartment syndrome is an important source of disability for military personnel, as well as high level athletes. […] This study represents the largest known cohort with chronic exertional compartment syndrome of the leg, and provides valuable information on the outcomes after elective fasciotomy in a physically active patient population. […] Symptoms recurred after the fasciotomy in 44.7% of the patients, and 27.8% of the patients were unable to return to full activity. […] Complications occurred in 15.7% of patients, usually involving wound infection, neurological complication, or wound dehiscence.

• #93 Registry Development and Non-Surgical Treatment Options for Chronic Exertional Compartment Syndrome — MIRROR | Musculoskeletal Injury Rehabilitation Research for Operational Readiness

  https://mirrorusuhs.org/mirror-projects/project5

  Military sports medicine clinics at Fort Belvoir Community Hospital (FBCH) and USU have been utilizing BoNT-A injections for the non-surgical treatment of CECS. A retrospective review of patients with CECS treated with BoNT-A at FBCH Sports Medicine Clinic from 2014 to 2017 provided data on twenty-nine patients who were treated with BoNT-A for CECS. […] The purpose of this grant application is to create a registry across all MTFs for CECS to compare diagnostic and therapeutic data. We will simultaneously assess the effectiveness of non-surgical treatments options for chronic exertional compartment syndrome as well as test the use of xylocaine injections to predict success for non-surgical or surgical options at selected sites.

• #94

  https://link.springer.com/article/10.1007/s40141-018-0184-y

  The goal of this paper is to review the current evidence on diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg. […] Research has shown promising outcomes with non-operative management including targeted alterations to running biomechanics. […] Innovations in the diagnosis of CECS include the use of continuous compartment pressure monitoring during exercise as well as some early research on the use of musculoskeletal ultrasound and particular MRI protocols of the lower leg. […] Future research is needed on alternative diagnostic modalities including musculoskeletal ultrasound and exercise MRI protocols and on alternative management strategies including botulinum toxin injection and ultrasound-guided fascial fenestration or fasciotomy. […] Significantly lower intramuscular pressure in the posterior and lateral compartments compared with the anterior compartment suggests alterations of the diagnostic criteria for chronic exertional compartment syndrome in the lower leg.

• #95

  https://link.springer.com/article/10.1007/s40279-022-01729-5

  The panel agreed that gait retraining and cessation of provoking activities are valuable components of a conservative treatment program. […] The panel agreed on the statement that a standardized institutional rehabilitation protocol should be used postoperatively. […] No consensus was achieved on management of recurrent or residual disease after surgical treatment. […] This three-round Delphi analysis established consensus on several aspects regarding the clinical practice guidelines for diagnosis and treatment of lower leg CECS in both civilian and military patient populations. […] The outcome of this Delphi analysis on CECS may serve as a platform to initiate simple guidelines for clinical practice.

• #96 Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies | Scientific Reports

  https://www.nature.com/articles/s41598-021-03825-4

  Chronic exertional compartment syndrome (CECS) is a condition occurring most frequently in the lower limbs and often requires corrective surgery to alleviate symptoms. Amongst military personnel, the success rates of this surgery can be as low as 20%, presenting a challenge in determining whether surgery is worthwhile. […] Surgical interventions in the form of compartment-specific fasciotomies have become a prominent method of treating CECS. […] Audits suggest that less than 45% of UK military personnel manage to return to a fully-fit state, with most recent evidence showing this number to be as low as 22%. […] Despite the problem of poor outcomes in military populations, only one study, to date, has sought to identify reasons as to why patients fail to have good surgical outcomes. […] The application of machine learning within orthopaedic medicine is a growing area, showing promise in treatment outcome prediction.

• #97 Demographic Characteristics Among Patients With Chronic Exertional Compartment Syndrome of the Lower Leg in: Journal of Sport Rehabilitation Volume 29 Issue 8 (2020)

  https://journals.humankinetics.com/view/journals/jsr/29/8/article-p1214.xml

  Minimal prospective evidence exists evaluating predictive factors for CECS. However, retrospective review has identified numerous commonalities in patients exhibiting CECS with regard to sex, age, and sport participation. […] CECS has been reported as a condition that commonly affects young, active individuals. […] Patients younger in age have been reported as having a higher likelihood for experiencing CECS in multiple studies. […] In addition, research suggests that sex is a characteristic that can influence the likelihood of CECS diagnosis. […] Participation in sport has been commonly associated with the development of CECS. […] Aside from age, sex, and sport participation, other factors mentioned in the literature include overuse, trauma, diabetes, and running mechanics. […] Future research should focus on additional prospective studies to further confirm common characteristics among those diagnosed with CECS as the current research is still controversial.

• #98 Chronic exertional compartment syndrome: current management strategies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6537460/

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. […] Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. […] Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. […] There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. […] Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

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