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chronic exertional compartment syndrome (CECS)

Epidemiology: - most commonly occurs in young athletes, especially runners Pathology: - exertion-provoked swelling of a specific muscle bed within a compartment of an extremity - the anterior compartment of the lower leg is the most common site Clinical manifestations: - case report [2] - throbbing bilateral anterior shin pain during exercise - resolves completely within 10 minutes - physical exam normal - throbbing pain, paresthesias, & sometimes weakness & foot drop during exercise, with complete resolution after rest Laboratory: - serum creatine kinase normal (case report [2]) Special laboratory: - lower extremity compartment pressure measurement at rest & with exertion Radiology: - Radiographs & MRI of bilateral tibias & fibulae are normal (case report [2]) Differential diagnosis: - peripheral arterial disease (PAD) - exercise cause pain earlier in PAD than CECS (median 4 vs 15 minutes)= - cessation of exercise alleviates pain almost immediately in all PAD patients - low-grade pain lingers at rest in most patients with CECS - symptoms bilateral in 1/2 of both PAD & CECS patients - CECS patients more likely to describe tightness, muscle weakness, & altered sensation during exercise [1] - shin splints Management: - modification of the exercise regimen & training surfaces - shoe inserts - gait retraining - if conservative measures are ineffective, surgical fasciotomy may be required [2]

General

compartment syndrome

References

  1. de Bruijn JA, Wijns KCA, van Kuijk SMJ et al Chronic exertional compartment syndrome in the differential diagnosis of peripheral artery disease in older patients with exercise-induced lower limb pain. J Vasc Surg. 2021 Jun;73(6):2114-2121 PMID: 33278541
  2. Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  3. Velasco TO, Leggit JC. Chronic exertional compartment syndrome: a clinical update. Curr Sports Med Rep. 2020;19:347-352. PMID: 32925373