Chronic exertional compartment syndrome

1. What occurs in CECS?
2. What are the clinical symptoms of CECS?
3. How is CECS diagnosed?
4. What is the best treatment for CECS?

Answers:
1. Pressure increases occur during and after exercise and nerve impingement and tissue ischemia can occur.
2. Pain with exercise that increases as the activity increases and diminishes after it stops. Weakness and numbness corresponds to the compartment being compressed (anterior and lateral CECS causes symptoms in deep peroneal distribution, deep posterior CECS in tibial nerve distribution). On palpation, the compartment may be firm and distal pulses may be diminished.
3. Compartment pressure studies measured pre and post exercise. A delay in return to pre-exercise pressure levels of 6-30 mins is required for diagnosis.
4. Fasciotomy.