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Chronic exertional compartment syndrome as a cause of anterolateral leg pain

Chronisches belastungsbedingtes Kompartmentsyndrom als Ursache anterolateraler Beinschmerzen

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Abstract

Exercise-induced leg pain (ELP) and tightness may be caused by a chronic exertional compartment syndrome (CECS). Although CECS can develop in any muscle compartment, most individuals suffer from an anterior tibial muscle CECS (ant-CECS). Typically, a patient with ant-CECS experiences discomfort toward the end of sports activity or in the hours thereafter. Physical examination may reveal tenderness upon palpation of the anterior tibial muscle belly. The gold standard diagnostic tool is a dynamic intracompartmental pressure (ICP) measurement demonstrating elevated muscle tissue pressures. Duplex analysis and imaging may be indicated for exclusion of concomitant entities such as entrapment of the popliteal artery or nerves. Conservative treatments including modification of the patient’s running technique can be successful. A fasciotomy must be considered in recalcitrant cases. Residual or recurrent disease may necessitate partial removal of the fascia. The aim of this overview is to discuss the management of CECS in the anterolateral portion of the leg.

Zusammenfassung

Belastungsinduzierte Beinschmerzen und Anspannung können durch ein chronisches belastungsbedingtes Kompartmentsyndrom („chronic exertional compartment syndrome“, CECS) verursacht werden. Ein CECS kann zwar in jedem Muskelkompartiment entstehen, aber die meisten Patienten leiden an einem CECS des M. tibialis anterior (ant-CECS). Typisch dabei ist, dass ein Patient mit ant-CECS bis zum Ende der sportlichen Aktivitäten oder in den Stunden danach Beschwerden hat. Bei der körperlichen Untersuchung kann sich Schmerzempfindlichkeit bei Palpation des Muskelbauchs des M. tibialis anterior zeigen. Goldstandard in der Diagnostik ist die dynamische intrakompartmentale Druckmessung („intracompartmental pressure“, ICP), die dann erhöhte Drücke im Muskelgewebe ergibt. Duplexuntersuchung und Bildgebungsverfahren können zum Ausschluss begleitender Erkrankungen wie einer Einklemmung der A. poplitea oder von Nerven indiziert sein. Die konservative Behandlung unter Einschluss einer Veränderung der Lauftechnik des Patienten kann erfolgreich sein. In hartnäckigen Fällen muss eine Fasziotomie erwogen werden. Bei einem Verlauf mit Residualbeschwerden oder Rezidiven wird möglicherweise eine Teilentfernung der Faszie erforderlich. Ziel der vorliegenden Arbeit ist es, die Behandlung eines CECS im anterolateralen Bereich des Beins darzustellen.

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Authors and Affiliations

  1. Máxima Medical Center, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands

    Johan de Bruijn, Michiel Winkes, Percy van Eerten & Marc Scheltinga

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  1. Johan de Bruijn
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  2. Michiel Winkes
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  3. Percy van Eerten
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  4. Marc Scheltinga
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Correspondence to Marc Scheltinga.

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J. de Bruijn, M. Winkes, P. van Eerten, and M. Scheltinga declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

The supplement containing this article is not sponsored by industry.

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M. Scheltinga, Veldhoven, NL

P. van Eerten, Veldhoven, NL

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de Bruijn, J., Winkes, M., van Eerten, P. et al. Chronic exertional compartment syndrome as a cause of anterolateral leg pain. Unfallchirurg 123 (Suppl 1), 8–14 (2020). https://doi.org/10.1007/s00113-019-0641-9

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