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Chronic Exertional Compartment Syndrome: Diagnostic Techniques and Management

Murray, Matthew C. MD; Heckman, Michael M. MD

doi: 10.1097/BTO.0b013e3182488423

Chronic exertional compartment syndrome is a common problem among running athletes. A complete history and physical are essential, and radiographic workup can distinguish between other types of leg pain. Intracompartmental pressure testing can accurately confirm the diagnosis. Nonoperative management is largely unsuccessful for those athletes unwilling to cease the inciting activity. Surgical management of the affected compartments with fasciotomy yields a high rate of satisfactory outcome and return to play. Techniques for fasciotomy in chronic exertional compartment syndrome have progressed from a complete open incision to minimally invasive “semi-blind” subcutaneous fasciotomy, and most recently, endoscopic techniques have been described. Although endoscopic methods have demonstrated improved cosmesis and visualization, there remains a risk of damage to neurovascular structures and recurrent symptoms due to incomplete fascial release. Postoperative course involves immediate weight bearing and early range of motion. With an accurate diagnosis, a meticulous surgical technique, and an aggressive early rehabilitation protocol, good outcomes can be expected with a return to play around 8 to 12 weeks.

Department of Orthopaedics, The University of Texas Health Science Center, San Antonio, TX

M.C.M. and M.M.H. state that this publication is their original work, and they declare no conflict of interest or external sources of support that require acknowledgement in this publication.

Address correspondence and reprint requests to Matthew C. Murray, MD, 7703 Floyd Curl Drive, M.C. 7774, San Antonio, TX 78229-3900. E-mail:

Received December 15, 2011

Accepted December 27, 2011

© 2012 Lippincott Williams & Wilkins, Inc.