Overview

Pathophysiology

History

Exam

Diagnosis

Treatment

Diagnosis

Following the history and physical, one should begin investigation with a plain x-ray. The next step should be a bone scan, preferably a Triple-phase bone scan to assist determination between stress fractures and medial tibial stress syndrome. Nerve conduction studies are of limited value and are generally not recommended. Occasionally a MRI will be of benefit if specific soft tissue abnormalities are strongly considered in the differential, but one must consider the cost/ benefit ratio.

Measuring compartment pressure is an effective way to confirm the diagnosis of CECS. The pressure is most commonly tested using an intracompartmental needle with pressure being measured with a closed system. A common tool is the Stryker Intracompartmental Pressure Monitor System. There is no gold standard for the diagnostic pressures to confirm the diagnosis but the most commonly used is as follows;

• A resting pressure greater than 20 mm Hg; or
• An exertional pressure greater than 30 mm Hg; or
• A pressure of 25 mm Hg or higher 5 minutes after stopping exercise