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Chronic Compartment Syndrome

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(Chronic Exertional Compartment Syndrome; Compartment Syndrome, Chronic; Compartment Syndrome, Exercise-induced; Compartment Syndrome, Recurrent; Exercise-induced Compartment Syndrome; Recurrent Compartment Syndrome; Exercise Myopathy)

Definition

Chronic compartment syndrome (CCS) occurs when pressure builds up within the body’s muscle compartments. Compartments are made of sheets of connective tissue called fascia. These sheets are under the skin of the arms and legs. They wrap around groups of muscles, nerves, and blood vessels. When pressure builds up in the compartments, it disrupts or blocks blood flow to the muscles.

Unlike acute compartment syndrome, CCS is not an emergency. But you should see your doctor to get treatment.

Compartment Syndrome in Lower Leg

Causes

CCS is most commonly caused by intense exercise.

Risk Factors

Participating in endurance sports increases your chance of getting CSS. You are at greater risk if you participate in sports that involve running or jumping.

Symptoms

CSS can affect the lower leg. But, it can also affect the arms, hands, feet, and buttocks. If you have any of these symptoms, do not assume it is due to CCS. These symptoms may be caused by other conditions.

Pain on both sides of the body, such as in both legs
Severe pain during exercise that typically goes away an hour after stopping
Fullness or tightness in the muscle
Tender, aching muscles
Muscle weakness
Numbness, tingling
In severe cases, foot drop—a foot slaps hard on the ground when running

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

You may have the pressure inside your compartments measured. This can be done with a slit catheter or tonometer.
Your doctor may ask you to perform range-of-motion stretches to assess the damage.
Your doctor may need to see pictures of your body structures. This can be done with:
- MRI scan
- CT scan

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Surgery

Surgery, called fasciotomy, is the main treatment for CCS. This is done to open the compartment and relieve pressure. A long slice will be made into the fascia to open the tissue and relieve pressure. It takes about three months to recover. You will have to do physical therapy.

Nonsurgical Approaches

If you decide not to have surgery, your doctor may recommend that you:

Stop the activity that is causing CCS and rest.
Change your training routine.
Do physical therapy.
Take anti-inflammatory medications or muscle relaxants.

Prevention

To help reduce your chance of getting CCS, take the following steps:

Avoid overexercising.
Change your training routine.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/

National Institutes of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

CANADIAN RESOURCES

Canadian Orthopaedic Foundation http://www.canorth.org

Physical Therapy Canada http://www.physicaltherapy.ca

References

Chronic compartment syndrome. American Academy of Podiatric Sports Medicine website. Available at: http://www.aapsm.org/chroniccompartment.html . Accessed January 31, 2013.

Compartment syndrome. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00204#Cause . Updated October 2009. Accessed January 31, 2013.

Compartment syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 24, 2011. Accessed January 31, 2013.

Stedman’s Medical Dictionary . 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005; 700;1894-1895.

Revision Information

Reviewer: John C. Keel, MD
Review Date: 09/2012 -
Update Date: 01/31/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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