The true incidence is unknown, as most people suffering from early symptoms will decrease or modify their activity without seeking out a healthcare professional. CECS is most commonly seen in runners, cyclists, and athletes in sports that demand running, jumping, and cutting, such as basketball and soccer. The risk of CECS is increased by anabolic steroids, which can induce muscle hypertrophy, thereby causing an increase in intracompartmental pressure and decreasing fascial elasticity. An increase in compartmental pressure interferes with blood flow, leading to ischemia and pain when the metabolic demands cannot be met. This has been coined chronic exertional compartment syndrome (CECS) and results from repetitive movements common in endurance sports. The overall incidence in complex pelvic surgeries may be as high as 1 in 500.Ĭhronic compartment syndrome occurs when the fascia in the lower leg does not accommodate to the increase in blood flow and fluid shifts that may occur with heavy exercise. Risk factors include the length of the procedure, the amount of leg elevation, the amount of perioperative blood loss, and the presence of peripheral vascular disease and obesity. This is known as “well leg compartment syndrome” and is most often seen after pelvic and perineal surgery. In patients with decreased mental status with prolonged limb compression, such as with alcohol or drug abuse, ACS can also develop from soft tissue injury and swelling.Īnother non-traumatic cause of compartment syndrome is ischemia leading to hyperperfusion, often caused by prolonged surgery in the lithotomy position. These include hemorrhage into a compartment, as can occur in anticoagulated patients, and compartment syndrome after diabetic muscle infarction. Non-traumatic causes of ACS are more rare. The anterior compartment is most commonly affected, although multiple compartments can be involved. ACS can occur in as many as 17% of tibial fractures. Direct pressure from a cast or antishock garment can increase the risk for compartment syndrome. ACS, most commonly occurring in males younger than 35 years, is most often caused by trauma such as fractures, crush injuries, muscle rupture, direct blow to a muscle, and circumferential burns. Untreated, ACS can progress to contractures, paralysis, infection, and gangrene in the limb as well as systemic problems, such as myoglobinuria and kidney failure. The focus of this chapter is compartment syndrome of the leg, although it can also affect the thighs or upper extremities.Īcute compartment syndrome (ACS) is a serious condition caused by a rapid rise in pressure in an enclosed space, which can lead to necrosis of the muscles and nerves in the involved compartment. With compartment syndrome, the pressures are elevated, especially after exercise.Compartment syndrome can be either an acute or chronic condition caused by increased tissue pressure within an enclosed fascial space. Pressures are measured at rest and then one minute and five minutes after exercise. These pressures are measured by using a special instrument that analyzes pressure through a needle placed in the muscle. MRI and other imaging studies have been used to diagnose compartment syndrome, but the standard diagnostic test is a measurement of the compartment pressures. The evaluation for compartment syndrome includes evaluating for other causes of leg pain such as medical tibial stress syndrome (shin splints), a stress fracture, a nerve entrapment or popliteal artery entrapment syndrome. The symptoms are typically relieved quickly when you stop the activity. You may develop muscle weakness and sensory disturbance in the involved compartment. Patients then experience an aching pain in the compartment that becomes sharp if they continue activity. Exertional compartment syndrome occurs when the muscles expand during exercise and the fascial covering around the muscles becomes too tight. Each compartment has a covering of fascia.

There are four compartments in the lower leg - one in the front, one on the outside, and two in the back (superficial and deep). In 82% of cases, the pain is in both legs. The condition is most common in runners, but it also occurs in other running sports including soccer, field hockey, basketball, and lacrosse.

The median age of onset is 20 years males and females are equally affected. Although the condition can occur in other compartments, 95% of cases are in the lower leg. Exertional compartment syndrome (ECS) is a condition that causes pain with exertion.

Fascial compartments of leg