Diagnosis and Management of Chronic Exertional Compartment Syndrome (CECS) in the United Kingdom.
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Clin J Sport Med. 2006 May;16(3):209-213
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I have been doing a little reading on Chronic exertional compartment syndrome and i have been curious on the use to non surgical means of treatment of the leg. The article above and a few others on the topic state the ineffectiveness of modalities such as deep massage, NSAID's, orthotics and stretching, though some did state that massage did elongate the time before the onset of pain.
So i am just wondering what non surgical treatment options are available? I have been unable to locate any articles which describe these in detail on medline and embase but has anyone else come across any? maybe NewsBot can help??
I know that this will depend on which compartment is involved and the aeitiology of the condition.
Has anyone had a large amount of success with non surgical means?
Also regarding surgery, fasciotomy is the treatment of choice it seems, how invasive are these procedures? i Believe that anterior and lateral compartments are less invasive than the deep posterior compartment. What is the length of the incision involved using the one incision or the two incision technique? I have read that they are using less invasive procedures though how less invasive are these?
Any information will help.
Thanks.
Chris -
I too have been reading on compartment syndrome-with more interest on the anterior area being affected chronically :D
I'm also dissapointed that most of the conservative modalities for treating the problem i.e. massage technique, ice packs, NSAID's etc. not being effective enough :mad:
And I always think of surgery as the last resort :eek:
Tish -
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I myself suffer from anterior compartment syndrome ad it is about as annoying as it comes. I was diagnosed with a rediculously high reading as i was concerned. From age 18 i suffered whilst road running for football training. After 12 mins my foot would burn and my anterior calf would ache and then my foot would go lame and prevent any dorsi or plantar flexion. Funnily enough it occurs exactly 12 minuites into any running, moreso affected in the summer during increased exercise regime by pre-season and unforgiving ground. Control shoes for my mild pronation never helped but combined with functional orthoses completely solved the problem until i dislocated my right knee, now the compartment syndrome is back but switched to the left leg, I felt my orthoses helped tremendously and is always an easier option than surgery to start with. Funnily enough I can run all day in my nike mercurial football boots with no trouble at all, even running home in my boots on the pavement...........
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Biomechanical overload syndrome: defining a new diagnosis
Andrew Franklyn-Miller, Andrew Roberts, David Hulse, John Foster
Br J Sports Med doi:10.1136/bjsports-2012-091241
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Management of Chronic Exertional Compartment Syndrome and Fascial Hernias in the Anterior Lower Leg With the Forefoot Rise Test and Limited Fasciotomy.
Finestone AS, Noff M, Nassar Y, Moshe S, Agar G, Tamir E.
Foot Ankle Int. 2013 Nov 22.
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Of course conservative treatments do not get rid of the problem but with mild anterior CECS I have had success in helping to push the "exertion line" back a bit.
I have a couple police officers who find that grinding the grip on the heel of their boot into a rocker helps.
I have had a couple runners who found orthotics and consciously limiting a rearfoot strike helped. With the orthotic, round off the posterior heel post.
Gradual warm up is critical.
Calf stretching during warm up and during exercise can help.
I've had success educating a couple people to massage their entire lower leg as symptoms are ramping up during a run or on an eliptical cross training machine. A quick 30 second massage on each each leg and a quick calf stretch can help push symptoms out for another few minutes, and occasionally keep them at bay for the rest of that workout session. Also educating people on where the exertional line is can help those who are trying to get gentle aerobic exercise.
If any of these were put to the test they would all fail, but I have folks reporting some success and returning to have mods done to their newest boot. -
Return to activity following fasciotomy for chronic exertional compartment syndrome
Val Irion, Robert A. Magnussen, Timothy L. Miller, Christopher C. Kaeding
European Journal of Orthopaedic Surgery & Traumatology; March 2014
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Return to Duty After Elective Fasciotomy for Chronic Exertional Compartment Syndrome
Jeremy R. McCallum et al
Foot & Ankle International July 21, 2014
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Intramuscular Compartment Pressure Measurement in Chronic Exertional Compartment Syndrome
New and Improved Diagnostic Criteria
David Roscoe, MRCGP, MFSEM(UK), MSc(SEM), DipIMC RCSEd, MPA, Andrew J. Roberts, MSc and David Hulse, MB ChB, MSc, FFSEM(UK)
Am J Sports Med November 18, 2014
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Feasibility and Safety of an Operative Tool for Anterior Chronic Exertional Compartment Syndrome Treatment
Johan A. de Bruijn et al
Foot & Ankle International July 28, 2015
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Ultrasound-Guided, Percutaneous Needle Fascial Fenestration for the Treatment of Chronic Exertional Compartment Syndrome: A Case Report
Jonathan T. Finnoff, DOcorrespondenceemail, Sathish Rajasekaran, MD
PM & R: Article in Press
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Isolated Chronic Exertional Compartment Syndrome of the Lateral Lower Leg
A Case Series
Aniek P.M. van Zantvoort et al
Orthopaedic Journal of Sports Medicine November 2015 vol. 3 no. 11
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Here is a short article I wrote on chronic exertional compartment syndrome about 15 years ago which briefly summarizes the condition.
Chronic Exertional Compartment Syndrome -
Endoscopic-assisted Release of Lower Leg Chronic Exertional Compartment Syndromes: Results of a Systematic Literature Review
Lohrer, Heinz MD, PhD; Nauck, Tanja PhD; Lohrer, Leif Stud. med.
Sports Medicine & Arthroscopy Review: March 2016 - Volume 24 - Issue 1 - p 19?23
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Botulinum Toxin for Chronic Exertional Compartment Syndrome: A Case Report With 14 Month Follow-Up.
Baria, Michael R. MD; Sellon, Jacob L. MD
Clinical Journal of Sport Medicine: January 16, 2016
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Surgical Management for Chronic Exertional Compartment Syndrome of the Leg: A Systematic Review of the Literature
Dominic Campano et al
Arthroscopy: The Journal of Arthroscopic & Related Surgery; 24 March 2016
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Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation
Daniel R. Lueders, M.D., Jacob L. Sellon, M.D., Jay Smith, M.D., Jonathan T. Finnoff, D.O.
PM & R; Article in Press
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BIOMECHANICAL DIFFERENCES BETWEEN CASES WITH CECS AND ASYMPTOMATIC CONTROLS DURING RUNNING
A Roberts et al
Br J Sports Med 2016;50:e4 doi:10.1136/bjsports-2016-096952.32
Abstracts from the International Sports Science + Sports Medicine Conference 2016
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BAREFOOT PLANTAR PRESSURE MEASUREMENT IN CHRONIC EXERTIONAL COMPARTMENT SYNDROME
D Roscoe et al
Br J Sports Med 2016;50:e4 doi:10.1136/bjsports-2016-096952.19
Abstracts from the International Sports Science + Sports Medicine Conference 2016
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BIOMECHANICAL DIFFERENCES BETWEEN CASES WITH CECS AND ASYMPTOMATIC CONTROLS DURING WALKING AND MARCHING
A Roberts et al
Br J Sports Med 2016;50:e4 doi:10.1136/bjsports-2016-096952.6
Abstracts from the International Sports Science + Sports Medicine Conference 2016
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MODIFYING MARCHING TECHNIQUE IN MILITARY SERVICE MEMBERS WITH CHRONIC EXERTIONAL COMPARTMENT SYNDROME: A CASE SERIES.
Helmhout PH et al
Int J Sports Phys Ther. 2016 Dec;11(7):1106-1124.
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Biomechanical differences between cases with chronic exertional compartment syndrome and asymptomatic controls during walking and marching gait
Andrew Roberts' et al
Gait and Posture; Article in Press
20 males with symptoms of chronic exertional compartment syndrome of the anterior compartment and 20 asymptomatic controls were studied. Three-dimensional lower limb kinematics and kinetics were compared during walking and marching.
Cases were significantly shorter in stature and took a relatively longer stride in relation to leg length than controls. All kinematic differences identified were at the ankle. Cases demonstrated increased ankle plantarflexion from mid-stance to toe-off. Cases also demonstrated less ankle inversion at the end of stance and early swing phases. Lower ankle inversion moments were observed during mid-stance.
The anthropometric and biomechanical differences demonstrated provide a plausible mechanism for the development of chronic exertional compartment syndrome in this population. The shorter stature in combination with the relatively longer stride length observed in cases may result in an increased demand on the anterior compartment musculature during ambulation. The results of this study, together with clinical insights and the literature suggest that the suppression of the walk-to-run stimulus during group marches may play a significant role in the development of chronic exertional compartment syndrome within a military population. The differences in joint angles and moments also suggest an impairment of the muscular control of ankle joint function, such as a reduced effectiveness of tibialis anterior. It is unclear whether this is a cause or consequence of chronic exertional compartment syndrome. -
Selective Fasciotomy for Chronic Exertional Compartment Syndrome Detected With Exercise Magnetic Resonance Imaging
Sehan Park, MD; Ho Seong Lee, MD, PhD; Sang Gyo Seo, MD
Orthopedics. 2017; 40 (6): e1099-e1102HTTPS:10.3928/01477447-20170608-03
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Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population
Johan A. de Bruijn et al
Int J Sports Med; DOI: 10.1055/s-0043-119225
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Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain
Kajsa Rennerfelt, Qiuxia Zhang, Jón Karlsson, Jorma Styf
MJ Open Sport & Exercise Medicine 2018;4:e000262
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Lower Leg Chronic Exertional Compartment Syndrome in Patients 50 Years of Age and Older
Johan A. de Bruijn et al
Orthopaedic Journal of Sports Medicine
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Identifying prognostic factors for conservative treatment outcomes in servicemen with chronic exertional compartment syndrome treated at a rehabilitation center.
Meulekamp MZ et al
Mil Med Res. 2017 Nov 28;4(1):36. doi: 10.1186/s40779-017-0145-2.
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Current Diagnosis and Management of Chronic Exertional Compartment Syndrome
Jeremy HartmanScott Simpson
Current Physical Medicine and Rehabilitation Reports: 24 March 2018
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Barefoot Plantar Pressure Measurement in Chronic Exertional Compartment Syndrome
D. Roscoe, A.J. Roberts, D. Hulse, A. Shaheen, M. Hughes, A. Bennett
Gait and Posture; Article in Press
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Patient-Reported Outcomes Following Fasciotomy for Chronic Exertional Compartment Syndrome
Jacqueline M. Maher, BA, Emily M. Brook, BA, Christopher Chiodo, MD, , , ...
Foot & Ankle Specialist June 22, 2018
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Intracompartmental Pressure Measurements in 501 Service Members with Exercise-related Leg Pain
Zimmermann, Wes O. et al
Translational Journal of the American College of Sports Medicine: July 15, 2018 - Volume 3 - Issue 14 - p 107–112
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Running mechanics of females with bilateral
compartment syndrome
Dai Sugimotoet al
J. Phys. Ther. Sci. 30: 1056–1062, 2018
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Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort
J. P. H. TamA. G. F. GibsonJ. R. D. MurrayM Hassaballa
European Journal of Orthopaedic Surgery & Traumatology: 25 August 2018
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Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up
Wes O Zimmermann et al
BMJ Open Sport & Exercise Medicine 2019;5:e000532
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Surgical outcomes for chronic exertional compartment syndrome following improved diagnostic criteria.
Simpson C wt al
J R Army Med Corps. 2019 Apr 16
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Features of Chronic Exertional Compartmental Syndrome of the Leg in Elite Nordic Skiers
Nadege Calvelli, samuel Vergès, Marie-Philippe Rousseaux-Blanchi, Pascal Edouard, Michel Guinot
Int J Sports Med
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Systematic Review of Outcome Parameters Following Treatment of Chronic Exertional Compartment Syndrome in the Lower Leg
S. Vogels E.D. Ritchie T.T.C.F. van Dongen M.R.M. Scheltinga W.O. Zimmermann R. Hoencamp
11 June 2020
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