Materiały źródłowe

• #1 Chronic exertional compartment syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-exertional-compartment-syndrome/diagnosis-treatment/drc-20350835

  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. […] Your doctor may initially recommend pain medications, physical therapy, athletic shoe inserts (orthotics), massage or a break from exercise. Changing how you land on your feet when you jog or run also might be helpful. However, nonsurgical options typically don’t provide lasting benefit for true chronic exertional compartment syndrome. […] Injections of botulinum toxin A (Botox) into the muscles of the leg may also help treat chronic exertional compartment syndrome, but more research needs to be done on this treatment option. Your doctor may use numbing injections beforehand to help map the affected area and determine what Botox dose is needed.

• #2 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 may respond to nonsurgical treatment and activity modification. If nonsurgical treatment doesn’t help, your doctor might recommend surgery. Surgery is successful for many people and might allow you to return to your sport. […] Taking a complete break from exercise or performing only low-impact activity might relieve your symptoms, but relief is usually only temporary. Once you take up running again, for instance, those familiar symptoms usually come back. […] 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.

• #3 Chronic exertional compartment syndrome

  https://www.mymlc.com/health-information/diseases-and-conditions/c/chronic-exertional-compartment-syndrome/

  Chronic exertional compartment syndrome may respond to nonsurgical treatment and activity modification. If nonsurgical treatment doesn’t help, your doctor might recommend surgery. Surgery is successful for many people and might allow you to return to your sport. […] 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. […] Your doctor may initially recommend pain medications, physical therapy, athletic shoe inserts (orthotics), massage or a break from exercise. Changing how you land on your feet when you jog or run also might be helpful. However, nonsurgical options typically don’t provide lasting benefit for true chronic exertional compartment syndrome.

• #4 Nonsurgical Treatment for Chronic Compartment Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/compartment-syndrome/treatments/nonsurgical-treatment-for-chronic-compartment-syndrome

  If chronic compartment syndrome is causing pain, weakness, numbness, or tightness in your muscles during or after exercise, your NYU Langone doctor may recommend avoiding high-impact exercise and using custom orthotic shoe inserts to relieve stress during physical activity. […] If symptoms persist or worsen, your doctor may recommend surgery. […] NYU Langone doctors recommend that people with chronic compartment syndrome rest the affected muscles. Avoiding the activity that causes symptoms can relieve pain and tenderness and prevent compartment syndrome from worsening. Low-impact workout routines, including swimming and cycling, are effective ways to maintain fitness without risking elevated pressure in the muscle compartments. […] Doctors may recommend non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce inflammation and swelling in the affected muscle compartments and alleviate pain.

• #5 Compartment Syndrome: What It Is, Symptoms & Treatments

  https://my.clevelandclinic.org/health/diseases/15315-compartment-syndrome

  Chronic compartment syndrome usually gets better and goes away if you rest your affected muscle compartments and avoid overusing them in the future. Your provider will suggest treatments to manage your symptoms and prevent pressure buildup, including: […] Chronic (exertional) compartment syndrome usually builds up over time. Frequent, intense exercise is the most common cause. […] Your provider may use a few tests to diagnose compartment syndrome, including: […] Chronic compartment syndrome treatment […] Chronic compartment syndrome usually gets better and goes away if you rest your affected muscle compartments and avoid overusing them in the future. Your provider will suggest treatments to manage your symptoms and prevent pressure buildup, including: […] Managing chronic compartment syndrome may take longer, especially at first. It might take a few months to find a combination of treatments and exercise modifications that manage your symptoms. Your symptoms should improve gradually as you find ways to avoid putting too much pressure on your affected muscles.

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

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

  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. […] Chronic compartment syndrome causes pain or cramping during exercise. This pain goes away when activity stops. It most often occurs in the leg. […] Nonsurgical treatment. Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines may be of limited benefit in relieving symptoms and generally do not allow return to full activity. […] Surgical treatment. If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so there is more room for the muscles to swell. […] 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.

• #7 Guide | Physical Therapy Guide to Compartment Syndrome | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-compartment-syndrome

  If you are diagnosed with compartment syndrome, your physical therapist will play an important role in the treatment of the condition, whether it requires surgery or not. Your physical therapist will work with you to design an individualized treatment program based on your condition and your personal goals. […] Your physical therapist may recommend: Range-of-Motion Exercises. Restrictions in the motion of your knee, foot, or ankle may be causing increased strain in the muscles housed within the compartments of your lower leg. […] Muscle Strengthening. Hip and core weakness can influence how your lower body moves, and can cause imbalanced forces through the lower-leg muscle groups that may contribute to compartment syndrome. […] Manual Therapy. Many physical therapists are trained in manual (hands-on) therapy, using their hands to move and manipulate muscles and joints to improve motion and strength.

• #8 A NON-OPERATIVE APPROACH TO THE MANAGEMENT OF CHRONIC EXERTIONAL COMPARTMENT SYNDROME IN A TRIATHLETE: A CASE REPORT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5159639/

  The purpose of this case report is to describe a non-operative, comprehensive approach to physical therapy, Functional Manual Therapy (FMT), in the treatment of a competitive triathlete with bilateral CECS who did not desire surgery. […] The use of a non-operative approach to treatment of CECS would be beneficial if it could prevent the risk, complications and costs related to surgical intervention. […] While it appears that CECS patients may have some improvement following manual therapy or functional training, alone these approaches do not appear to be sufficient in assisting the patient to full recovery. […] The episode of care lasted 3.5 months during which the subject was seen 1-2 visits/week for a total of 23 visits. […] Following the FMT clinical reasoning paradigm, interventions addressed mechanical capacity, neuromuscular function and motor control impairments across the lower quadrant aiming to address all aspects of the movement system.

• #9 Nonsurgical Treatment for Chronic Compartment Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/compartment-syndrome/treatments/nonsurgical-treatment-for-chronic-compartment-syndrome

  NYU Langone doctors advise wearing shoes that have ample arch support and a cushioned sole when exercising. […] Podiatrists or physical therapists at NYU Langone can custom-fit orthotic shoe inserts to improve your foots alignment. […] For those with chronic compartment syndrome, an orthotic shoe insert may redistribute weight across the foot in a way that allows you to continue running or participate in other high-impact activities without muscle pain.

• #10 Chronic exertional compartment syndrome

  https://www.head2toeosteopathy.com/post/chronic-exertional-compartment-syndrome

  Chronic exertional compartment syndrome (CECS) is a common condition affecting runners and other endurance athletes. It is characterised by the development of increased pressure within the muscle compartments during exercise, leading to pain and discomfort. While CECS can be challenging to manage, there are several effective strategies available to help runners recover and prevent further complications. […] In many cases, conservative treatment options are effective in managing CECS. These strategies focus on reducing the pressure within the affected muscle compartments and alleviating symptoms. Some common conservative treatments include: […] Rest and Modification of Activities: Reducing or temporarily avoiding activities that trigger symptoms can help alleviate pain and promote healing. It is essential to listen to your body and give it adequate time to recover.

• #11 Chronic Exertional Compartment Syndrome (CECS) – Sports Clinic NQ

  https://sportsclinicnq.com.au/chronic-exertional-compartment-syndrome-cecs/

  Compartment syndrome generally does not get better on its own. Therefore if you have or suspect you have compartment syndrome it is advised you seek the assistance of a sports medicine professional. […] The latter should consist of deep massage of the compartment (area of soreness) followed by ice to reduce any post-massage soreness. […] Compartment syndrome does not produce any long-term effects, as long as it is properly diagnosed and appropriately treated. […] Weight loss: When you gain weight the muscle has to work harder and there is potentially more mass in the compartment which increases pressure. […] Soft tissue treatments: Including massage may be useful to decrease the degree of muscle swelling. […] Surgery: Surgery to cut the sleeve of connective tissue surrounding the compartment is necessary in some cases, as this enables the muscle to expand during exercise without increasing pressure.

• #12 Chronic Compartment Syndrome | Kingsley Physio | More than your local Physio

  https://kingsleyphysio.com/common-conditions/chronic-compartment-syndrome/

  Release of the affected calf muscles this may take the form of deep-tissue massage, stretching, dry needling or procaine therapy (also called wet needling. It involves the injection of local anaesthetic into the effected muscles). […] Lumbopelvic core stability and strengthening this is a long-term programme and can take numerous forms. Specific muscles around the lower back, pelvis and abdomen will be strengthened to facilitate support of the lumbar spine during exercise. […] When conservative management fails a surgical fasciotomy (or partial fasciotomy) may be suggested. This is an operation whereby the fascial layer around the affected muscle group is cut. […] The majority of patients surgically treated for CCS experience a high level of pain relief and are satisfied with the results of their operation.

• #13 Solutions for Exertional Compartment Syndrome in Runners | Baltimore Peripheral Nerve Surgeon | Dr. Eric H. Williams

  https://www.baltimoreperipheralnervepain.com/blog/solutions-for-exertional-compartment-syndrome-in-runners.cfm

  Chronic exertional compartment syndrome is a condition many runners are all too familiar with. […] The first thing to try if you are dealing with compartment syndrome is a period of rest from running or other activities related to the pain. Runners may also try to adjust their running style so that they land on their forefoot rather than their heel with each stride. […] In many cases, surgery is the best option for ongoing relief from compartment syndrome. The surgical approach is known as fasciotomy, which is a procedure that creates slits in the compartments of the lower leg to allow room for them to expand during exercise. […] An alternative to a fasciotomy is nerve release surgery which frees up nerves that are compressed by the muscles that have expanded as a result of compartment syndrome. This procedure can relieve the symptoms of compartment syndrome and get a runner back on the track.

• #14 Emerging Treatment for Compartment Syndrome – Sports Medicine Review

  https://www.sportsmedreview.com/blog/emerging-treatment-compartment-syndrome/

  Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. […] Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. […] One of the first reports involved 16 patients and 41 total compartments and showed a significant decrease with elimination of exertional pain in 94 percent of intracompartmental pressures for up to 9 months. […] An unpublished retrospective review of CECS patients treated with botulinum toxin A injections at the Ft. Belvoir Military Sports Medicine Clinic shows that 66% (19/29) of the patients returned to their desired activity level.

• #15 A NON-OPERATIVE APPROACH TO THE MANAGEMENT OF CHRONIC EXERTIONAL COMPARTMENT SYNDROME IN A TRIATHLETE: A CASE REPORT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5159639/

  Chronic Exertional Compartment Syndrome (CECS) causes significant exercise related pain secondary to increased intra-compartmental pressure (ICP) in the lower extremities. CECS is most often treated with surgery with minimal information available on non-operative approaches to care. This case report presents a case of CECS successfully managed with physical therapy. […] The patient chose non-operative care and was treated with physical therapy using the Functional Manual Therapy approach aimed at addressing myofascial restrictions, neuromuscular function and motor control deficits throughout the lower quadrant for 23 visits over 3.5 months. […] This case report describes the successful treatment of a triathlete with Functional Manual Therapy resulting in a return to competitive sports without pain.

• #16 A NON-OPERATIVE APPROACH TO THE MANAGEMENT OF CHRONIC EXERTIONAL COMPARTMENT SYNDROME IN A TRIATHLETE: A CASE REPORT

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5159639/

  The subject was deemed a good candidate for physical therapy given his age, motivation, and active lifestyle. […] The subject was seen for a total of 23 visits over three and a half months. At the time of discharge the subject had returned to running and training pain free with an 18-point improvement in the LEFS to 80/80, surpassing the 9-point MCID and the MDC. […] This case report presents the application of FMT, a comprehensive approach to physical therapy, in the treatment of a competitive athlete diagnosed with CECS.

• #17 Chronic exertional compartment syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-exertional-compartment-syndrome/diagnosis-treatment/drc-20350835

  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. […] Sometimes, a fasciotomy can be performed through small incisions, which may reduce recovery time and allow you to return to your regular sport or activity sooner. […] Although surgery is effective for most people, it’s not without risk and, in some cases, it may not completely alleviate symptoms associated with chronic exertional compartment syndrome. Complications of the surgery can include infection, permanent nerve damage, numbness, weakness, bruising and scarring.

• #18 Chronic exertional compartment syndrome

  https://www.mymlc.com/health-information/diseases-and-conditions/c/chronic-exertional-compartment-syndrome/

  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. […] Although surgery is effective for most people, it’s not without risk and, in some cases, it may not completely alleviate symptoms associated with chronic exertional compartment syndrome. Complications of the surgery can include infection, permanent nerve damage, numbness, weakness, bruising and scarring.

• #19 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. […] Operative treatment of CECS with fasciotomy has been shown to be effective in resolution of CECS, and new surgical techniques are being developed. […] Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. […] The mainstay of surgical treatment of CECS is fasciotomy, given its increased success rate compared to nonoperative management. […] More research is needed to investigate outcomes after surgical release of specific compartments or combinations thereof. […] Although outcomes after compartment release for the treatment of CECS are generally favorable in civilians, studies in the military population have shown lower success rates.

• #20 Chronic exertional compartment syndrome: current management strategies

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

  The endoscopic, minimally invasive technique has resulted in an overall 79.5% return-to-sports rate in the pediatric population. […] The use of botulinum toxin A injections (Botox) has been proposed as a novel treatment for CECS. […] 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. […] Studies of higher quality and power are needed to better understand the efficacy and outcomes of the newer surgical techniques.

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

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

  Nonoperative management of athletes with CECS always includes activity modification and essentially giving up aggravating activity or sport. This is often not a compatible option with dedicated, elite athletes. Presently there are no medical remedies available to treat CECS. […] Because most patients with CECS wish to remain active, surgical treatment is the standard of care. This procedure involves incising the tough compartment envelope (fascia) and as a result allowing the increase in compartmental volume with exercise without obligatory increase in pressure which results in CECS Several fasciotomy techniques exist. Open two incision fasciotomy involves longitudinal incisions on the inside and outside of the leg and the longitudinal fascial release of two compartments through each incision. A minimally invasive release through small incisions can be achieved through two limited longitudinal incisions, but with the assumption of slightly greater risk to the nerves and blood vessels that cannot be seen. Camera-assisted (endoscopically assisted) two incision fasciotomy has also been described with reported the same safety margin as the single incision technique. Some surgeons utilize single-incision techniques for ACS and CECS fascial release but it is more technically demanding and potentially less reliable in a complete release of the fascia.

• #22 Treatment of Exertional Compartment Syndrome | Baltimore Peripheral Nerve Surgeon | Dr. Eric H. Williams

  https://www.baltimoreperipheralnervepain.com/library/treatment-of-exertional-compartment-syndrome.cfm

  A period of rest or focus on low-impact activities can provide relief from the symptoms of exertional compartment syndrome. Unfortunately, however, the syndrome is likely to flare up again once a person returns to their usual athletic endeavors. […] As a result, your doctor may recommend surgery to correct the issue. One option might be whats known as a fasciotomy, a procedure that cuts the tightened tissue around the muscle. For some patients this may be treatment enough, however, other patients may also have a component of nerve compression which may require additional nerve releases in addition to the compartment releases. […] Another option may be nerve release surgery, which frees nerves that are being compressed by the affected muscles. This surgical solution is not dissimilar from the treatment, for example, of carpal tunnel syndrome, another condition that involves the ongoing compression of a nerve that leads to significant discomfort, pain, and function issues. Releasing the nerve leads to relief of the symptoms.

• #23

  https://www.adelaideankle.com.au/CECS

  Reduced activity, anti-inflammatory medications, physiotherapy and ice are used in all cases for a minimum of three months. […] Surgery for CECS involves increasing the size of the affected compartment(s) by fasciotomy. […] Release of the anterior and/or lateral compartments relieves CECS pain by three months in 80% of people. […] People requiring posterior compartment release take longer to recover and only 65% are significantly better. […] Both legs can have surgery at the same time. […] 65 – 80% of people are helped by surgery. […] 20 – 35% of people are not helped by surgery. […] 5% of people are made worse by surgery.

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

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

  Most common complications of the surgical fasciotomy procedures include an insufficient release with recurrence of symptoms reported in up to 17% of patients. In addition hemorrhage, hematoma formation, wound infection, nerve injury, vascular injury, persistent edema, perceived weakness and deep vein thrombosis have all been reported with incidence ranging from 4-13%. Despite these reported complications, a well-done operation can yield 80-100% successful resolution of symptoms in athletes. […] Immediately after surgery, the athlete undergoes pain and swelling management with medications, elevation, and icing. Active range of motion exercise is not restricted postoperatively and is encouraged to begin immediately. Crutches are utilized for comfort and weight bearing is not restricted. Once the incisions are healed patient can begin progressive activities as tolerated and generally can return to full activities in 3-4 weeks after the procedure. Therefore, patients are expected to return to light activity in 2-4 weeks and full sporting activities in 4-6 weeks.

• #25 Guide | Physical Therapy Guide to Compartment Syndrome | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-compartment-syndrome

  Modalities. Your physical therapist may use modalities (such as ultrasound, iontophoresis, moist heat, cold therapy) as a part of your rehabilitation program. […] Education. Your treatment will include education about how to safely return to your previous activities, particularly if your condition required a fasciotomy. […] If you need surgery (either due to an injury or chronic condition), physical therapy after surgery will be essential to a successful recovery. Your physical therapist will work closely with your surgeon regarding the nature of your procedure, expected timelines for healing, and your progress during rehab.

• #26

  https://journals.lww.com/cjsportsmed/fulltext/2022/07000/chronic_exertional_compartment_syndrome_caused_by.4.aspx

  After hypothesizing the cause of CECS as venous outflow obstruction, all patients underwent an imaging-guided botulinum toxin injection of the affected area. At an average of 20.7 1.8 weeks after treatment, repeat stress CTA was performed in 197 patients. Of those, 155 patients [78.7% 5.7% (95% CI)] showed normalization or significant improvement of venous patency at the site of botulinum toxin injection. This demonstrates the effectiveness of targeted botulinum toxin at relieving muscle-induced venous occlusion. Furthermore, 227 of 284 patients [79.9% 4.7% (95% CI)] described reduced or resolved symptoms with exercise 3 to 4 weeks after treatment. Residual venous occlusion at sites not treated or the emergence of new compression sites was likely responsible for the persistence or return of symptoms. The significant resolution of pain after relief of venous occlusion provides further evidence that CECS is caused by functional venous outflow obstruction.

• #27 Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up | BMJ Open Sport & Exercise Medicine

  https://bmjopensem.bmj.com/content/5/1/e000532

  Objectives To assess the outcome of conservative treatment for chronic exertional compartment syndrome (CECS) as it relates to the reduction in surgical fasciotomy and return to active duty in a military population. […] A conservative treatment programme for anterior CECS was able to return 65 % of patients to active duty, without surgery. At 2 years, the success rate decreased slightly, but remained positive at 57%. In this high-risk group, initiating a conservative treatment protocol with an emphasis on gait retraining can significantly reduce the need for surgical fasciotomy. For those that fail conservative treatment, surgical release may still be indicated. […] In the military, treatment for anterior chronic exertional compartment syndrome may be initiated with a special conservative approach before fasciotomy.

• #28 Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up | BMJ Open Sport & Exercise Medicine

  https://bmjopensem.bmj.com/content/5/1/e000532

  The conservative treatment programme should at least contain gait retraining of running and marching, in shoes and boots. […] The number of surgical procedures can be reduced significantly; however, surgery is still indicated when conservative treatment is not effective. […] This study illustrates the impact of anterior CECS on service members and the military organisation. It also demonstrates the diversity of possible treatment outcomes, active duty, with or without transfer to a less physically demanding specialty, and continuing work with different levels of exercise-related leg pain symptoms, as reflected by the follow-up SANE scores. […] In conclusion, for patients with anterior CECS in the military population, initiating care with a comprehensive conservative treatment protocol can have a two-third return to duty rate while avoiding surgery and reduce the total number of fasciotomies required. At follow-up, on average more than 2 years later, 57% of patients surveyed were active duty, without surgery (follow-up treatment success). Surgical fasciotomy may still be effective and reasonable in patients who fail the comprehensive conservative first protocol.

• #29

  https://link.springer.com/article/10.1007/s11932-003-0055-9

  Chronic exertional compartment syndrome of the lower leg is a well-described and documented cause of exercise-related pain in recreational, elite, and military athletes. […] Conservative therapy is minimally effective. […] Fasciotomy is the treatment of choice for athletes who are unwilling to modify their exercise or sport.

• #30 Compartment Syndrome: Symptoms and Treatment | Doctor

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

  Chronic exertional compartment syndrome most often occurs in the lower legs, but occasionally occurs in the thighs, upper arms, forearms and hands. Most people have symptoms in both legs. […] Surgical treatment involving decompressive fasciotomy, which is effective in relieving pain and increasing exercise tolerance in most patients. […] Fasciotomy is the treatment of choice for athletes who are unwilling to modify their exercise or sport.

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

  https://sems-journal.ch/8207

  Athletes suffering from CECS are at elevated risk of developing a non-reversible condition such as acute exertional compartment syndrome. Unfortunately, the likelihood of success of conservative treatment strategies such as eccentric training, stretching, and adaptation of running technique is limited. Occasionally, clinical examination and gait analysis reveal biomechanical alterations such as pes planovalgus. Therefore, foot orthotics with arch support to correct over-pronation while running may provide some relief to symptomatic patients. Patients with concomitant venous insufficiency might benefit from utilization of compression stockings. […] Nevertheless, conservative treatment should be continued for at least 3 to 6 months before considering surgical interventions such as fasciotomy. When surgical treatment is considered, a major challenge for sports physicians is the identification of an appropriate time slot within the course of the season. Patients who underwent compartment release within 12 months of symptoms had improved outcomes in terms of postoperative satisfaction compared to individuals who had to wait longer for surgical release. Thus, 81% of patients who underwent operation experienced satisfying results, whereas success rate of non-operative treatment appeared to be about 41% within a mean follow-up of almost 6 years. Surgical fasciotomy may be performed either open (with crural incisions up to 10 cm in length), or endoscopically assisted. Regardless of technique, when a fascial herniation is present, it must be included in the release to attain successful results.

• #32 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. 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. Gait retraining is an attractive alternative to fasciotomy. A newer proposed treatment is the intramuscular administration of onabotulinumtoxin A, also known as botulinum toxin A or BoNT-A into the muscles of the involved compartment(s). 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. BoNT-A is FDA approved for intramuscular, intradetrusor, or intradermal use for muscle spasticity, migraine headaches, detrusor instability and severe forehead lines, lateral canthal lines, and glabellar lines in adults. The purpose of this grant application is to create a registry across all MTFs for CECS to compare diagnostic and therapeutic data.

• #33

  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 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. […] Traditionally, management of CECS starts with conservative measures. Gait retraining and botulinum injections may have positive outcomes. If conservative interventions fail or if a patient experiences severe symptoms, surgical treatment is considered. Fasciotomy is the described surgical intervention, opening the fascia enveloping the affected muscle with an open, a minimally invasive, or an endoscopic technique.

• #34 Treatment of Exertional Compartment Syndrome | Baltimore Peripheral Nerve Surgeon | Dr. Eric H. Williams

  https://www.baltimoreperipheralnervepain.com/library/treatment-of-exertional-compartment-syndrome.cfm

  It is, of course, vitally important to get a correct diagnosis (exertional compartment syndrome is, for example, sometimes mistaken for shin splints) and to consider what treatment options might be most effective for you. Your doctor can identify the problem and walk you through your options so that together you can make an informed choice about how best to move forward with the goal of getting you back to your regular activities without ongoing pain. […] Dr. Williams has the expertise and experience required to make the correct diagnosis and to recommend the best course of treatmentup to and including nerve release surgery.

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