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Last update 08 May 2025

Chronic Exertional Compartment Syndrome

Last update 08 May 2025

Basic Info

Synonyms

Chronic Exertional Compartment Syndrome, Chronic exertional compartment syndrome, 慢性労作性コンパートメント症候群

+ [1]

Introduction

Compartment syndrome characterized by pain in muscle groups with elevated compartment pressures due most often exercise training in athletes. Most often encountered chronic exertional compartment syndrome is in the anterior or deep posterior compartments of the lower leg in athletes in training similar to POPLITEAL ARTERY ENTRAPMENT SYNDROME.

Drugs associated with Chronic Exertional Compartment Syndrome

Perflutren lipid microsphere

Target-

Mechanism

Ultrasonography enhancers

Active Org.

Lantheus EU Ltd. [+6]

Originator Org.

Lantheus Medical Imaging, Inc.

Active Indication

Heart Diseases [+3]

Inactive Indication

Adnexal Diseases [+4]

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

United States

First Approval Date31 Jul 2001

Clinical Trials associated with Chronic Exertional Compartment Syndrome

NCT05466539

/ RecruitingPhase 4IIT

Chronic Exertional Compartment Syndrome (CECS) Evaluated With Needle Manometry and Shear Wave Elastography, and Treated With Ultrasound-Guided AbobotulinumtoxinA

Chronic Exertional Compartment Syndrome (CECS) is a painful condition affecting runners and it is caused by a reversible increase in pressure within a closed compartment in the leg. Currently, to diagnose CECS, a large needle is placed into the muscle to measure pressure, which is invasive and painful. After diagnosis, the gold standard of treatment is surgery, which is also invasive, involves a prolonged return to play, and has a significant number of treatment failures. A growing literature has suggested alternative methods to both diagnosis and treatment that include the use of ultrasound to investigate muscle stiffness with shear wave elastography (SWE), and treatment with botulinum toxin injection into the muscle.
The investigators propose a single-site randomized clinical trial to investigate the use of abobotulinumtoxinA in the treatment of CECS. Researchers also look to develop a non-invasive method for the diagnosis of CECS using SWE. To the researchers' knowledge, this is the first randomized study investigating the medication to treat this cause.
The study will take place at Emory's outpatient sports medicine clinic. Potential participants will primarily be identified and recruited from the departments of Physical Medicine and Rehabilitation, Orthopedics, Physical Therapy, and Sports medicine as a part of regular clinical care. Participants will be included in the randomized portion of the study if they meet the previously established diagnostic criteria for CECS with compartmental pressure testing.
This would be a landmark study to provide evidence for the use of an abobotulinumtoxinA in the treatment of CECS, leading to the potential avoidance of a surgical procedure. It could also change the means of diagnosis without the use of painful and invasive needle pressure testing that would provide patients and athletes with ease of care.

Start Date25 Apr 2024

Sponsor / Collaborator

Emory University

[+1]

NCT05765071

/ Not yet recruitingNot ApplicableIIT

Treatment of Lower Leg Anterolateral Chronic Exertional Compartment Syndrome With Intra-muscular Botulinum Injections.

The goal of this pilot triple-blind randomized clinical trial is to determine the effectiveness of intra-muscular botulism injection for treatment of lower leg anterolateral chronic exertional compartment syndrome (CECS).
Primary Research Question: What is the effectiveness of intra-muscular botulinum injection, compared to normal saline placebo, for reducing pain related to painful sport activity in patients with lower leg anterolateral chronic exertional compartment syndrome (CECS), over a 24-week period?
Secondary outcomes will measure the time to initial onset and duration of pain during the painful sport activity, characterize the type of pain, foot paraesthesias, self-reported ankle instability, and ankle dorsiflexion and eversion muscle power. The Single Assessment Numeric Evaluation (SANE) score will provide a measure of overall leg function.
Adult patients with a confirmed diagnosis of anterolateral CECS, as determined by post-exertional compartment pressure measurements, will be invited to participate in the study. Using concealed, consecutively-numbered randomization envelopes, participants will be randomly assigned to receive either the botulinum (treatment) or the normal saline (control) injection. Participants will answer a web-based outcome questionnaire at Baseline (prior to receiving the injection) and at 2, 4, 6, 8, 12, 16, 24-weeks follow-up. Participants will be asked to do their painful sport activity the day before completing the questionnaire. Ankle dorsiflexion and eversion muscle power will be manually measured by a physiatrist in clinic at 6, 16 and 24-week follow-up visits.

Start Date01 Jun 2023

Sponsor / Collaborator

University of Calgary

[+1]

NL-OMON56011

/ RecruitingNot Applicable

Validation of CPM#1 compressibility in healthy volunteers in rest and after exercise - Non-invasive measurement of compartment pressure: Reliability

Start Date02 Feb 2023

Sponsor / Collaborator

Maxima Medisch Centrum Nl

100 Clinical Results associated with Chronic Exertional Compartment Syndrome

100 Translational Medicine associated with Chronic Exertional Compartment Syndrome

0 Patents (Medical) associated with Chronic Exertional Compartment Syndrome

485

Literatures (Medical) associated with Chronic Exertional Compartment Syndrome

01 May 2025·Journal of Pediatric Orthopaedics

Intermediate Duration Outcomes of Surgical Management for Chronic Exertional Compartment Syndrome in Adolescents and Young Adults: The Mubarak Fasciotome

Article

Author: Bomar, James D. ; Wilson, Katherine D. ; Edmonds, Eric W.

Objective:Chronic exertional compartment syndrome (CECS) poses challenges in diagnosis and management, particularly in young athlete populations. Current surgical approaches have been successful after failed conservative management, but with only short-term follow-up detailed in the literature. This study aimed to evaluate intermediate outcomes (>2 y) of surgical management for CECS in adolescents and young adults using the Mubarak fasciotome, with attention to complications and patient-reported outcomes.Methods:A retrospective review of patients identified over a 13-year period who underwent lower extremity fasciotomy was performed. Those with CECS were included based on the history of lower extremity symptoms and elevated intracompartmental pressure readings meeting Pedowitz criteria. Fasciotomy was performed with the Mubarak fasciotome under general anesthesia. Single-incision approaches were used for anterior/lateral compartments, and/or a medial incision for posterior compartments. Patients received postoperative therapy and underwent patient-reported outcomes assessment, including MARX and SANE scores, and pain ratings at various time points and final follow-up. Descriptive statistics were calculated using SPSS.Results:We identified 6 patients (10 limbs) undergoing fasciotomy for CECS with a mean follow-up of 7.2 years (range: 2 to 12.5 years). Following surgery, patients reported significant improvements in pain, with mean scores decreasing from 7.7 to 1.5. MARX scores indicated a return to high physical activity, with a mean of 8.7. SANE scores for activities of daily living and athletics were high, indicating functional recovery. Yet only 66% of patients returned to their original sport or a comparable activity level. No major complications were noted.Conclusion:The Mubarak fasciotome for CECS surgery in adolescents and young adults resulted in favorable intermediate outcomes that persist throughout the athlete’s career, including pain reduction, functional improvement, and high satisfaction. This minimally invasive technique offers a promising alternative to traditional fasciotomy when careful attention is placed on fasciotome placement to avoid nerve injury.

01 May 2025·Clinical Journal of Sport Medicine

Fasciotomy for Chronic Exertional Compartment Syndrome of the Deep Posterior Lower Leg Compartment: A Prospective Study

Article

Author: Janssen, Loes ; de Bie, Rob ; Goossens, Sari ; Scheltinga, Marc ; van den Heuvel-Weiss, Chris ; van Eerten, Percy

Objective:Patients with lower leg deep posterior chronic exertional compartment syndrome (dp-CECS) experience exercise-induced calf pain and tightness. Retrospective studies suggest that outcome after a fasciotomy is suboptimal. This prospective case series determined success rates of a fasciotomy and identified factors predicting outcome.Design:Severity and intensity of pain and tightness were scored at baseline (BL) and 3 and 12 months postoperatively (follow-up [FU]3, FU12). Outcome measures were symptoms, return to sports, and patient-reported success.Patients:Data of patients with dp-CECS (n = 74, 51% males, age 28 ± 12 years) operated between 2013 and 2022 in a single center were analyzed.Results:Pain scores during rest and during exercise were greatly attenuated (rest BL: 8 ± 1, FU3: 4 ± 1, FU12: 3 ± 0; exercise BL: 20 ± 1, FU3: 8 ± 1, FU12: 8 ± 1; both P < 0.001). At FU3, rates of success and return to sports were 56% and 63%, respectively. At FU12, success was maintained in 48% and 80% had returned to sports. Length of symptom duration and not opening the flexor hallucis compartment were related to a lower chance of return to sports (P < 0.05).Conclusions:Outcome after a fasciotomy for lower leg dp-CECS is successful in approximately half of patients. Long duration of symptoms and not opening the flexor hallucis compartment are risk factors for failure.

01 Mar 2025·Clinical Journal of Sport Medicine

Exertional Compartment Syndrome Strategies for Evaluation and Management

Review

Author: Strauss, Michael ; Xian, Sammy ; Chan, Adam ; Wilson, Katherine

Objective:The exertional compartment syndrome (ECS) is often a delayed diagnosis. Compartment pressure measurements (CPM) confirm the diagnosis. Herein we present our algorithm for the evaluation and management (E&M) of ECS. It avoids multiple CPM and shows the importance of the history and examination for E&M of the ECS.Design:A literature review showed that limb abnormalities are hardly ever mentioned. Subsequently we show how the history, examination (for recognizing abnormalities), and CPM integrate with our algorithm for E&M of the ECS.Setting:Our algorithm evolved for a 32-year interval and approximately 150 ECS evaluations.Patients:Our E&M method was used for the above complement of patients.Interventions:The symptomatic muscle compartment(s) and the severity of pain during the inciting activity are ascertained. The examination detects abnormalities and tautness of muscle compartments. This information integrated into our ECS algorithm establishes which compartments need CPM.Main Outcome Measures:Pain severity is quantified on a 0- to 10-point scale. This information is integrated with history, examination findings, and CPMs to guide E&M for a range of ECS presentations.Results:Abnormalities detected on the examination often explain why ECS occurs. This information is valued by the patient, minimizes CPM, and offers sound advice for E&M.Conclusions:Our article heightens awareness of the ECS diagnosis for all levels of care providers. It objectifies pain severity, shows the importance of the examination, and minimizes ECM in giving advice to the referral sources.

News (Medical) associated with Chronic Exertional Compartment Syndrome

17 Aug 2022

·www.nsmedicaldevices.com

Millar secures TGA approval for sale of Mikro-Cath Pressure Catheter in Australia

The Mikro-Cath is a single-use pressure catheter designed for use in diagnostic and research procedures in medicine to measure intra-compartmental, airway, and cardiovascular pressures in humans Millar receives TGA approval for its Mikro-Cath Pressure Catheter. (Credit: Elisabeth from Pixabay) Medical device maker and OEM solutions partner Millar has received approval from the Therapeutic Goods Administration (TGA) in Australia for their Mikro-Cath Pressure Catheter. The Mikro-Cath is a single-use pressure catheter designed for use in diagnostic and research procedures in medicine. The catheter is recommended for measuring intra-compartmental, airway, and cardiovascular pressures in humans. According to the firm, it can be utilised as a limited-contact, minimally invasive device for only 24 hours. The regulatory expansion will provide Australian physicians and clinical researchers access to high-fidelity pressure data that is reliable and unaffected by patient movement or position. The technology provides ease of calibration to get access to data faster, a clean, accurate signal to eliminate the guesswork during analysis, and real-time data directly from the source. The company said the device is also suitable for diagnosing chronic exertional compartment syndrome (CECS) where a continuous intramuscular pressure signal during exercise can be helpful. Millar chief commercial officer Matt Davis said: “This approval has been long-awaited, and we look forward to working with Australian clinicians who are interested in acquiring the most comprehensive and reliable cardiovascular, airway, and compartment pressure data. “As a nation of sports enthusiasts, we anticipate that this regulatory approval will also open an opportunity for an improvement in patient care within the compartment syndrome monitoring space in Australia.” The Millar Mikro-Cath is authorised for measuring intra-compartmental pressures, airway pressures, and cardiovascular pressures in the US and Europe in addition to Australia. For more than 50 years, Millar has produced MEMS sensor-enabled catheters that provide the most accurate assessment of physiologic pressures. The catheters have been applied to advance medical research and the development of devices for orthopaedic, cardiovascular, respiratory, and neurosurgical applications.

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