Introduction and History

Chronic exertional compartment syndrome (CECS) is a condition in which patients experience pain with exercise that usually subsides with resting.1 CECS is defined as increased pressure within a closed fibro-osseous space that can cause reduced blood flow and tissue perfusion within that space. These changes within a confined compartment can lead to ischemic pain and damage to the tissues of that compartment. However, pain is relieved relatively quickly with rest and there is typically no permanent damage to the tissues. CECS is often a recurrent condition that is associated with repetitive exertion. CECS is often seen among athletes with elevated exercise regiments that push their intra-muscular pressures within the affected compartment to become painful and tight, preventing them from further activity.2 CECS can present itself as being acute or chronic. Acute compartment syndromes, whether introduced by repetitive exertion or by way of trauma, require immediate attention to prevent irreversible damage to the tissues of the offending compartment. Patients that present with acute compartment syndromes will often display symptoms of severe pain that is exacerbated with passive stretch of the muscles and does not resolve with immediate resting. Development of parenthesis and pallor can be followed by the loss of pulse in the distal extremity. Acute compartment syndromes often occur following high-energy trauma with or without an open fracture. Exercise-induced acute compartment syndrome may not develop symptoms until 24-48 hours following exercise.2 Wilson first described exertional compartment syndrome in 1912 in an expedition to Antarctica.3 The symptoms of CECS were later described by Vogt in 1943 as “March Gangrene.” It was not until 1962 that French and Price first documented elevated intracompartmental pressures in the lower extremities as the cause of chronic exertional compartment syndrome. Surgical treatment by way of a fasciotomy was first described by Mavor in 1956.2 ANATOMY