Lower extremity compartments fasciotomy full#
Lower extremity compartments fasciotomy professional#

Interestingly, patients with CECS of the lower leg have fascial defects over the anterolateral lower leg at four to five times the rate of asymptomatic individuals.

Additionally, muscle fascial herniation may be evident on inspection of the limb, especially with contraction of the affected muscle groups within a compartment. However, patients with long-standing severe CECS may exhibit point tenderness and atrophy of the affected compartment.

In the clinical setting, physical exam of patients with CECS is often unremarkable. 4 Despite a lack of consensus on the exact pathophysiology, repetitive exertion of the muscles within a compartment leading to decreased perfusion is accepted as the primary pathway to the onset of symptoms in CECS. 21 Other factors that have been implicated in playing a role in CECS include improper training, limb malalignment, leg-length discrepancy, running technique, and uncoordinated muscle control. 20 In addition, patients with CECS tend to have increased total intramuscular pressure at rest compared to controls. 18, 19 Studies have shown the total intramuscular pressure of patients with CECS remains overall higher than unaffected individuals, even in patients who are postfasciotomy. 2, 4, 6 While the exact pathophysiology leading to increased compartment pressure is not well understood, it is accepted that the cause is likely multifactorial, with muscle hypertrophy, decreased venous return, microtrauma, myopathies and noncompliant fascia playing a role.

The symptoms of CECS are secondary to decreased blood flow due to increased compartment pressures. 17 The purpose of this review is to provide a brief overview of the etiology and diagnosis of CECS and up-to-date understanding of the current management strategies for CECS in the adult and pediatric populations. This contrasts starkly with acute compartment syndrome, which can be limb-threatening if not emergently addressed. 4 Symptoms rapidly improve with rest, typically without permanent sequelae in the affected tissue. 5, 14– 16ĬECS is characterized by a reversible increase in pressure within an inelastic fascial compartment leading to compromised tissue perfusion and subsequent pain and neurologic symptoms. 5, 12, 13 Although early outcome research on CECS was based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females.

Lower extremity compartments fasciotomy professional#

8– 10 Upper-extremity CECS is most commonly seen in rowers 11 and professional motorcyclists. 1– 6 Lower-extremity CECS is most often observed in running athletes 7 and marching military members.

Lower extremity compartments fasciotomy full#

Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.Ĭhronic exertional compartment syndrome (CECS), first described in 1912, is a rare clinical diagnosis that occurs more frequently in the lower extremity than the upper extremity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. There have been fewer studies on upper-extremity CECS, given its rarity. Nonetheless, larger samples and a more diverse population are needed to better understand the outcomes of nonoperative management. 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. In the pediatric population, endoscopy-assisted compartment release has provided high success rates with low complication rates. Operative treatment of CECS with fasciotomy has been shown to be effective in resolution of CECS, and new surgical techniques are being developed. Needle manometry can be used to confirm diagnosis of CECS by measuring intracompartmental pressure. Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. Lower-extremity CECS is most often observed in running athletes and marching military members. Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations.