Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Anterior Compartment Fasciotomy for Exertional Compartment Syndrome


Chronic exertional compartment syndrome (CECS) has been described in the upper extremities, spine, thigh, and most commonly, in the lower leg. The incidence of CECS in athletes with exercise-induced lower leg pain is reportedly as high as 27%. There is a roughly equal distribution of CECS between male and female athletes.

Most information regarding the physiology of exertional compartment syndrome comes from the acute compartment syndrome often seen in military recruits. The pathology of acute compartment syndrome involves intracompartment pressures rising to extremely high levels, potentially causing irreversible ischemia to muscle and nerve tissue. CECS tends not to reach the same high-pressure levels of acute exertional compartment syndrome. The lower pressures of CECS do not cause irreversible ischemia, but do frequently limit an athlete’s activity or duration thereof.

Indications

  • Pain in the leg localized to the anterolateral area.

  • A diagnosis of exclusion and inclusion (other entities must be eliminated before this diagnosis is considered).

  • Often part of the wastebasket diagnosis of “shin splints” which can be stress fracture, periostitis, or exertional compartment syndrome. One has to exclude mass effects from tumors in the leg or vascular disease/malformations. Also trauma has to be excluded.

  • The symptoms start with exertion and increase. Whereas a normal person may be able to exercise at a certain level for a certain amount of time, someone with this entity notes severe pain sooner during exercise with much longer time to resolution after exercise (Roscoe et al., 2014).

Examination/Imaging

  • The leg may not be abnormal at rest. However, if the patient is encouraged to exercise in the exam room (or sent out to run around the block), the leg becomes swollen and painful. The anterior compartment is tense on palpation. The pain is often accompanied by dysesthesias into the ankle and foot.

  • A pressure monitor can be used to confirm the diagnosis. An indwelling wick catheter can be used if desired to graph the pressure of the compartment over time. Often this is a bilateral condition.

  • Objective pressure measurements: (1) a preexercise pressure >15 mm Hg; (2) a 1 minute postexercise pressure of >30 mm Hg; or (3) a 5 minute postexercise pressure >20 mm Hg.

  • If there is an associated equinus contracture, it may cause the anterior compartment to overpull against the tight calf.

  • Radiographs

    • Radiographs of the leg can be used to rule out stress fracture of the tibia.

  • Magnetic Resonance Imaging

    • Magnetic Resonance Imaging can show periostitis, stress fractures, masses within the leg that might be causing symptoms, or other abnormalities of the marrow.

Treatment Options

  • Physical therapy can often decrease symptoms. If the anterior compartment is overwhelmed by a tight calf (overloaded trying to overcome the equinus contracture), aggressive calf stretching can help. However, nonoperative treatment rarely eliminates the pain in a true anterior exertional compartment syndrome.

Surgical Anatomy

  • The anterior compartment of leg is comprised of the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and the peroneus tertius.

  • The anterior tibial artery and deep peroneal nerve travels superficial to the interosseous membrane, between the tibialis anterior and extensor hallucis longus.

  • See equinus contracture release (Procedure 76) if being done in conjunction with anterior release.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts