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Chronic Compartment Syndrome

(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 and nerves.
Unlike acute compartment syndrome, CCS is not an emergency. However, you should see your doctor to get treatment.
Compartment Syndrome in Lower Leg
Compartment Syndrome
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Causes

CCS is most commonly caused by intense exercise.

Risk Factors

CCS usually occurs in people less than 30 years old. Risk factors include:
  • Participating in endurance sports
  • Participate in sports that involve running or jumping
  • Anabolic steroid and creatine use
  • Eccentric exercise
  • Poor biomechanics in runners

Symptoms

CSS can affect the lower leg. However, 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.
  • Severe pain during exercise that typically goes away an hour after stopping
  • Pain on both sides of the body, such as in both legs
  • 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:

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 cut 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 are only had CCS for a short time or 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.
  • Custom made orthotics.

Prevention

To help reduce your chance of getting CCS, take the following steps:
  • Avoid overexercising.
  • Change your training routine.
  • Avoid anabolic steroids and creatine

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

Canadian Physiotherapy Association http://www.physiotherapy.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. Chronic exertional compartment syndrome of the leg. Alicia K. Tucker. Curr Rev Musculoskelet Med. 2010 October; 3(1-4): 32–37.

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

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