Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome is a muscle and nerve disorder brought on by activity that affects the legs or arms and produces discomfort, swelling, and occasional paralysis. The illness can affect anybody, but young adult runners and athletes who engage in repetitive impact sports are more likely to acquire it.

Chronic exertional compartment syndrome may benefit from activity moderation and nonsurgical therapy. If nonsurgical therapy is unsuccessful, your doctor could suggest surgery. Many people have favorable surgical outcomes, and you might be able to resume your sport thereafter.

Chronic Exertional Compartment Syndrome: Causes

It is unclear what causes persistent exertional compartment syndrome. The volume of your muscles increases as your work out. The tissue (fascia) that surrounds the problematic muscle doesn't grow with the muscle if you have chronic exertional compartment syndrome, which results in pressure and discomfort in a compartment of the affected limb.

According to some specialists, the way you move when working out may contribute to chronic exertional compartment syndrome. Some potential reasons include having muscles that swell excessively when you exercise, having a fascia around the afflicted muscle compartment that is very rigid, or having high blood pressure.

Chronic Exertional Compartment Syndrome: Symptoms

You have particular muscle regions in your limbs (compartments). For instance, your lower leg contains four compartments. On both sides of the body, generally the lower leg, chronic exertional compartment syndrome frequently affects the same compartment of the afflicted limb.

Among the warning, signs, and symptoms are −

• Discomfort that is dull, sharp, or cramping in a particular area of the afflicted limb

• The afflicted limb is tense

• Tingling or numbness in the afflicted limb

• Limb weakness that is being influenced

• In extreme situations, foot drop if the legs are damaged

• Occasionally, a muscular hernia can cause swelling or bulging.

Chronic exertional compartment syndrome pain often has the following characteristics −

• Begins repeatedly as you begin exercising the afflicted leg, regardless of the amount of time, distance, or effort.

• Gradually gets worse as you exercise

• Within 15 minutes of ceasing the exercise, the intensity decreases or ends altogether.

• Recovery period following exercise may lengthen over time.

• Your symptoms could be relieved by taking a total vacation from exercise or engaging in just low-impact activities, although relief is typically only momentary. For example, if you start jogging again, those recognizable symptoms frequently return.

When to Visit a Doctor?

See your doctor if you have persistent, unexpected discomfort, swelling, weakness, loss of feeling, or soreness when working out or taking part in sports.

Often shin splints, a more prevalent cause of leg discomfort in young individuals who engage in a lot of strenuous weight-bearing exercise like running, are confused with chronic exertional compartment syndrome. See your doctor if you believe you have shin splints and the pain does not go away with rest and self-care.

If you receive the right care, chronic exertional compartment syndrome is not a life-threatening illness and often doesn't have a permanent negative impact. Yet, you might be unable to exercise or engage in your sport at the same degree of intensity if you have chronic exertional compartment syndrome due to discomfort, weakness, or numbness.

Chronic Exertional Compartment Syndrome: Risk Factors

Your chance of getting chronic exertional compartment syndrome is increased by several circumstances, such as −

• Age. Although anybody can acquire chronic exertional compartment syndrome, male and female athletes under the age of 30 are the ones most likely to do so.

• Workout style. Your chance of getting the illness rises when you engage in repetitive impact exercise like jogging.

• Overtraining. Your chance of developing chronic exertional compartment syndrome might also increase if you exercise too frequently or vigorously.

Chronic Exertional Compartment Syndrome: Diagnosis

To rule out other reasons, such as shin splints or stress fractures, your doctor may first try to rule out other exercise-related disorders that are more frequent than chronic exertional compartment syndrome.

Physical exam findings for chronic compartment syndrome due to excessive effort are frequently unremarkable. Your physician might want to see you after you've worked out enough to cause symptoms. Your doctor could see tension, pain, or a protrusion in the afflicted muscle.

MRI Scan

The anatomy of the muscles in the compartments may be examined and other potential causes of your symptoms can be ruled out using a standard MRI scan of your legs.

The compartments' fluid contents may be evaluated with the use of a sophisticated MRI scan. Pictures are captured before, during, and after the workout while your foot is at rest. The effectiveness of this sort of MRI scan in identifying chronic exertional compartment syndrome suggests that it may eliminate the necessity for invasive compartment pressure testing.

Spectroscopy in the Near Infrared (NIRS)

The quantity of oxygen in your blood in the damaged tissue is measured using NIRS, a more recent technology. The test is administered both before and after exercise. This enables you to assess whether the blood supply to your muscles has diminished.

Tests of Compartment Pressure

Your doctor could advise evaluating the pressure inside your muscle compartments if imaging tests do not reveal a stress fracture or other comparable source of discomfort.

The gold standard for identifying chronic exertional compartment syndrome is this examination, sometimes known as a compartment pressure measurement. Before and after exercising, a needle or catheter is inserted into your muscle as part of the test to take measurements.

Compartment pressure measurement is generally not done unless your medical history and other tests indicate you have this problem because it is intrusive and moderately uncomfortable.

Chronic Exertional Compartment Syndrome: Treatment

Both nonsurgical and surgical treatments are available for persistent exertional compartment syndrome. Nonsurgical treatments, however, usually only work if the condition-causing behavior is stopped or significantly reduced.

Non-surgical Alternatives

First, your doctor could advise anti-inflammatory drugs, physical therapy, orthotics (sports shoe inserts), massage, or a hiatus from exercise. It could be beneficial to alter the way you land on your feet when you jog or run. Nonsurgical treatments, however, are frequently ineffective for treating real chronic exertional compartment syndrome.

Operative Choices

The most successful method of treating chronic exertional compartment syndrome is a surgical surgery termed a fasciotomy. It entails slicing apart the rigid tissue covering each damaged muscle compartment. Pressure is reduced as a result.

Little incisions can occasionally be used to do a fasciotomy, which may speed up healing and enable you to resume your usual sport or activity.

Although surgery is helpful for the majority of patients, it is not without danger, and in certain situations, the symptoms of chronic exertional compartment syndrome may not entirely disappear. The procedure may result in complications such as infection, long-term nerve damage, numbness, paralysis, bruising, and scarring.

Chronic Exertional Compartment Syndrome: Prevention

One can take the following preventive measures to avoid this condition −

• Instead of doing too much too soon, increase workout endurance gradually.

• While you work out, you should adopt new body postures (for example, mixing up your gait when you run).

• Increasing adaptability.

• Avoid overworking your muscles.

• Using appropriate footwear.

• Exercising on surfaces that are softer and easy on your body.

Conclusion

Young people who have post-exercise discomfort may have chronic exertional compartment syndrome, which has to be surgically addressed. This condition is underdiagnosed and should be taken into consideration. Confirming the diagnosis requires measuring the compartment pressure.