This pressure buildup causes pain and sometimes subtle motor weakness and/or paresthesias in the corresponding neurovascular sensory and motor distributions. In the setting of CECS, there is ultimately a rise in the pressure within one or multiple musculofascial compartments, which impedes further muscle expansion, eventually compromising blood flow once the volume and pressure reach a level that overrides the capillary perfusion pressure. During exercise, specific muscle compartments swell up to 20%, secondary to increased blood flow and fluid volume. The literature consistently reports the clinical underappreciation of ECS types, particularly the acute subtype, given that there is most commonly an atraumatic presentation. The major differentiating clinical variable separating the two forms of ECS from ACS is the absence of a specific traumatic event in the former. The article provides an overview of the hallmarks and diagnostic considerations surrounding both forms of ECS, including the importance of clinicians maintaining a high index of suspicion to avoid delays in diagnosis. ECS typically occurs in the lower leg but can also occur in other areas like the forearm, thigh, or hand. Just as in acute compartment syndrome (ACS), the diagnosis implies a surgical emergency requiring fasciotomies to help mitigate the risks of ensuing irreversible muscle ischemia and neurovascular injury, which can occur after just a few hours alone. Īcute exertional compartment syndrome (AECS) is a rare entity that, unfortunately, its diagnosis is often delayed. Although benign, the refractory nature of CECS often results in a substantial portion of patients ultimately electing to proceed with fasciotomies. There are two distinct forms of exertional compartment syndrome, acute and chronic types.Ĭhronic exertional compartment syndrome (CECS) occurs in the setting of recurrent, reversible ischemic episodes following the cessation of activity resulting in the predictable decrease in fascial compartment pressures. Exertional compartment syndrome is often a diagnosis of exclusion and occurs secondary to increased pressures in a muscular compartment, with resultant ischemia manifesting most commonly as pain.
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