Chronic Compartment Syndrome

Right Diagnosis is the key to successful treatment 

Patient's story 

Diagnosis

Acute compartment syndrome is a condition that occurs due to the increase in pressure of a muscular compartment, generally after trauma such as a fracture or surgery. It is common knowledge to most doctors coming out of medical school with its classic 6Ps:

  • pain,

  • pulselessness,

  • pallor,

  • paralasis,

  • poikilothermia and

  • paraesthesia

However, the chronic variant is a much less frequently discussed topic.  This often leads to lengthy delays to diagnosis despite it being the cause of 27% of chronic anterior leg pain (Tucker 2010). It shares many features in common with its acute cousin, the main difference being that whereas in acute compartment syndrome the increase in pressure in a muscular compartment is due to trauma, the increase in chronic compartment syndrome is generally caused by exercise.

 

Chronic Compartment Syndrome

Chronic Compartment Syndrome can affect any compartment of the leg, most commonly the anterior compartment and frequently affects more than one at once. (de Bruijn et al. 2020) This then leads to similar symptoms of swelling, pain, weakness and sometimes neurological symptoms (depending on the degree of pressure and the compartment affected) which start after a certain duration of activity (Berry, Barrazueta & Ruchelsman 2017). 

These may present less of an emergency than the acute version which can risk loss of limb if untreated but these can nevertheless be debilitating – causing athletes to give up their sports or in severe situations may not resolve and become acute compartment syndrome. (Chandwani & Varacallo 2021) These symptoms are often missed as when the patient is being examined, they have no signs or symptoms, the symptoms resolve fairly soon after exercise and so the patient must be examined while exercising (Paik, Pepples & Hutchinson 2013). 

 

Common pit fall

It is also commonly mistaken for shin splints (medial tibial stress syndrome, where tenderness occurs over the posteromedial border of the tibia due to traction from the muscle attachments), stress fracture or claudication due to vascular disease. 

References:

Tucker, A 2010, 'Chronic exertional compartment syndrome of the leg', Curr Rev Musculoskelet Med, vol 3, no. 1-4, pp. 32-37.

De Bruijn, J, Van Zantvoort, A, Van Klaveren, D, Winkes, M, Van der Cruijsen-Raajmakers, M, Hoogeveen, A, Teijink, J & Scheltinga, M 2018, 'Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population', Int J Sports Med, vol 39, no. 1, pp. 58-66.

Berry, L, Barrazueta, G & Ruchelsman, D 2017, 'Chronic exertional compartment syndrome in athletes', J Hand Surg Am, vol 42, no. 11, pp. 917-23.

Chandwani, D & Varacallo, M 2021, 'Exertional Compartment Syndrome', Statpearls.

Paik, R, Pepples, D & Hutchinson, M 2013, 'Chronic exertional compartment syndrome', BMJ.

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