Emerging Treatments for Compartment Syndrome introduction Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations.
Emerging Treatments for Compartment Syndrome introduction Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists.
The proposed pathophysiology is increased pressure in muscle compartments during exercise that can result in muscle tightness and pain, which can then advance to paresthesia, muscle weakness, and exercise intolerance. CECS predominantly involves the lower extremities, primarily affects active young adults, and negatively impacts running or other endurance activities Needle manometry can be used to confirm diagnosis of CECS by measuring intracompartmental pressure. Additionally, 28% of these patients were unable to return to full activity, 16% suffered surgical complications, and 6% required repeat fasciotomy.
Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. Larger samples and a more diverse population are needed to better understand the outcomes of nonoperative management. This post will be an evaluation and update on the current evidence for the treatment of CECS with botulinum toxin A.
One of the first reports involved 16 patients and 41 total compartments and showed a significant decrease with elimination of exertional pain in 94 percent of intracompartmental pressures for up to 9 months. Eleven of the patients (69%) did have a decrease in strength, however. Belvoir Military Sports Medicine Clinic shows that 66% (19/29) of the patients returned to their desired activity level.
Additionally, 20 patients were satisfied or somewhat satisfied with their treatment, and 12 patients continued to have sustained relief at the time of follow-up. However, seven patients experienced a recurrence of their symptoms with 7.8 months mean duration of improvement. Ninety-one percent (10/11) of patients who underwent both BoNT-A injections and fasciotomy reported a favorable response to botulinum toxin A before their surgery, suggesting that intramuscular botulinum toxin A injections for CECS might predict fasciotomy success.
If you are experiencing symptoms that may be related to emerging treatment options for chronic exertional compartment syndrome, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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