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The diagnosis of chronic exertional compartment syndrome (CECS) is commonly delayed due to the poor use of terminology by athletes, and many clinicians, that virtually any pain in the leg is ‘shin splints’. We will be able to provide our patients with a better serviceif we can target a more specific diagnosis with earlier and focused treatment. Therefore, when the history and presentation are most consistent with a stress fracture, radiographs and possibly an MRI or a bone scan should be obtained. If the pain is posterior and related to blood flow, venous or arterial Doppler studies or magnetic resonance angiography should be obtained to confirm the diagnosis of a blood clot or popliteal artery syndrome. Finally, when the history includes increasing pain with exertion with associated resolution with rest, the working diagnosis of CECS should be confirmed with intracompartmental pressure testing. Although alternative techniques using infrared sensors have been proposed,1 most experts agree that intracompartmental pressure testing is the gold standard.
Key questions, however, remain regarding the specific protocol a clinician should undergo when performing intracompartmental pressure testing. Should both legs be tested? Should the isolated, most symptomatic compartment or all four compartments be routinely tested? Are resting, immediate postexertion and delayed postexertion tests required for adequate testing?
Classic use of intracompartmental pressure measurements was established for the diagnosis of acute and not CECSs. In general, the clinical presentation for an acute compartment syndrome is more obvious with exquisite, unrelenting pain associated with a palpably tense compartment. In these cases, it is reasonable to test only the suspicious compartment. Indeed, it is within the standard of care to proceed with a fascial release in the acute setting even without confirming elevated pressures with an intracompartmental pressure measurement. For CECS, the standard of care is to confirm the diagnosis …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.