Chronic compartment syndrome: tips on recognizing and treating: the patient's history offers more important clues than physical exam

Journal of Family Practice,  Nov, 2005  by Jon Englund

• E-mail
• Print
• Link

Explanations for why certain individuals are unable to tolerate this exercise-induced increase in muscle volume include abnormally thickened or stiff fascia, muscle hyper-trophy, local scarring secondary to a soft tissue injury. (5) and venous hypertension. (1,2) This hypertension can result from a Baker's cyst, a DVT, or use of an excessively tight-fitting knee brace. (6)

FAST TRACK

Though the debate is unesolved, most clinicians agree that the symptoms of CCS are due to local ischemia

FAST TRACK

Most patients with CCS have normal clinical exams; an exam's real value is to detect signs associated with other disorders.

A profile of chronic compartment syndrome

Chronic compartment syndrome was first identified by Mavor in 1956, (12) but it was not until 1975 that the disorder's clinical manifestations and basic pathophysiology were described. (13) CCS is an uncommon condition and no published data exist regarding its incidence or prevalence. However, because more physicians are becoming aware of it, CCS is being increasingly recognized. At the University of Wisconsin, the number of patients diagnosed with CCS has more than tripled in each of the last 2 decades. (1,2)

Athletes most affected. CCS, also known as exertional compartment syndrome or effort-related compartment syndrome, affects primarily young athletes. The mean age of afflicted persons at the time of diagnosis is mid to late twenties. The average duration of symptoms before diagnosis is 2 years. (1) The syndrome most commonly affects runners and soccer players, but other sports linked to the development of CCS are cycling, football, gymnastics, and tennis. (1,2,3,7) Although the syndrome most commonly affects the lower extremities, many reported cases of CCS have occurred in the forearms and hands.

Young women may be most at risk. Early studies from the United States in the mid-1980s showed that the male to female ratio of affected patients was approximately 1:1. (2,8) However, a large, more recent study showed a female-to-male ratio greater than 2:1. (1) This likely reflects the increase in female sports participation over the last 2 decades and suggests that females may be at a greater risk of developing the syndrome.

FAST TRACK Intracompartmental pressure measurement is the gold standard of diagnosis--resting pressure >15 mm Hg is abnormally elevated

Jon Englund, MD Fellow, South Bend Primary Care Sports Medicine Fellowship Program, South Bend, Indiana

CORRESPONDING AUTHOR Jon Englund, MD, Memorial Healthplex Sports Medicine Institute, 111 West Jefferson, South Bend, IN 46601. E-mail: jon.englund@aurora.org

Table 1

Differential diagnosis for
chronic compartment syndrome

Shin splints
Stress fracture
Gastrocnemius/Soleus strain
Claudication
Disk herniation
Spinal stenosis
Peripheral neuropathy
Popliteal artery entrapment syndrome
Peroneal nerve entrapments
Osteomyelitis

Tumor

COPYRIGHT 2005 Dowden Health Media, Inc.
COPYRIGHT 2008 Gale, Cengage Learning