Chronic exertional compartment syndrome, or CECS, is an uncommon source of pain and disability in athletes. Most frequently, it causes leg pain in running athletes, but occasionally it is seen in the forearms of throwing athletes, such as pitchers. In the leg, it is often misdiagnosed as the more common shin splints or stress fractures.
What is CECS?
Compartment syndrome occurs when the muscles of part of the body swell with activity. In runners, this muscle swelling occurs in part or all of the leg. This swelling causes discomfort or even severe pain while the athlete is running, but it usually gets better with rest. Over time, this swelling and pain increase to the point that it limits the runner’s ability to complete a training session. He or she will often notice, in addition to pain and swelling, numbness and tingling in the foot. As symptoms progress, the athlete might notice pain with activities of daily living, such as fast walking. Pitchers who experience this problem will have similar symptoms, noting forearm pain with throwing and numbness and tingling in the fingers. This type of compartment syndrome differs somewhat from compartment syndrome that occurs after traumatic injuries, such as tibia fractures, as the swelling in those cases can be surgical emergencies.
Signs and symptoms of chronic exertional compartment syndrome
Chronic exertional compartment syndrome can be a difficult problem. Athletes can have swelling of their muscles and subsequently pain with activity and numbness and tingling that often do not respond to nonsurgical treatments. Rest can be helpful, but often when the athlete goes back to that particular activity or sport, the problem returns quickly. The problem in exertional compartment syndrome is that the fascia, or the tissue that surrounds the muscle compartments, can only stretch so much. Therefore, when the muscle swells in these athletes, there is only so much room for the muscles before pain develops and the nerves and blood vessels in these compartments get compressed.
Surgery for CECS
If athletes continue to have symptoms from chronic exertional compartment syndrome, surgical treatment is usually the best option. Surgery involves making incisions in the skin to expose the fascial covering over the muscle compartments. The fascia is released, and the skin is closed outside of the muscle compartments. This procedure gives the muscles room to swell, alleviating pressure on the nerves and blood vessels. If the diagnosis is correct, and if the surgery adequately releases the muscle compartments, athletes are very likely to return to sports without symptoms.