Exertional Compartment Syndrome

1. See Also
   1. Compartment Syndrome
2. Pathophysiology: Sites involved
   1. Leg (most common)
   2. Forearm
   3. Thigh
   4. Gluteal region
3. Symptoms
   1. Exercise-induced pain and swelling relieved with rest
   2. Acute Exertional Compartment Syndrome
      1. Similar presentation as in Compartment Syndrome
   3. Chronic Exertional Compartment Syndrome
      1. Gradual aching extremity pain
      2. Bilateral extremity involvement in 50 to 70%
      3. Sensation of fullness over involved compartment
      4. Pain begins predictably after Exercise start
         1. Fixed time interval into Exercise routine or
         2. Specific intensity level
      5. Pain relieved with 20 minutes of rest
      6. Pain recurs on resuming Exercise
4. Signs
   1. Perform exam immediately after Exercise
   2. See Compartment Syndrome
5. Diagnosis: Intracompartmental Pressure Monitor Criteria
   1. Readings are only valid if Exercise reproduces symptoms
   2. Pre-Exercise resting pressure exceeds 10 to 15 mmHg
   3. Pressure 5 minutes post-Exercise over 15 to 25 mmHg
   4. Post-Exercise elevated pressure despite 15 minutes rest
6. Differential Diagnosis
   1. Stress Fracture
   2. Periostitis
7. Radiology
   1. Extremity XRay
   2. Triple phase bone scan
      1. Stress Fracture: Transverse linear pattern
      2. Shin Splint: Longitudinal linear uptake
8. Management: Acute Exertional Compartment Syndrome
   1. Immediate Fasciotomy
   2. See Compartment Syndrome
9. Management: Chronic Exertional Compartment Syndrome
   1. Modify extrinsic factors
      1. Training surface
      2. Athletic shoe
      3. Training intensity
   2. Modify intrinsic factors (e.g. hindfoot pronation)
      1. Strengthening Exercises
      2. StretchingExercises
      3. Orthotics
   3. Surgery for recurrent symptoms over 3 months
      1. Fasciotomy
      2. Postoperative rehabilitation
         1. Week 0: Range of motion Exercises
         2. Week 1: Weight bearing
         3. Week 2: Stationary bike
         4. Week 3: Isokinetic strengthening Exercises
         5. Week 5: Running
         6. Week 8: Speed and agility training
10. References
    1. Abramowitz (1994) Orthop Rev 23(3):219-25
    2. Detmer (1985) Am J Sports Med 13(3): 162-70
    3. Edwards (1996) Physician Sportsmed 24(4):31-46