| Chronic | |||
| Exertional | |||
| Compartment | |||
| Syndrome | |||
Exam
The signs of CECS are typically absent at the time of exam. For this reason, the patient should perform the exercise that induces symptoms. Prior to this, office evaluation should include an exam to rule out other possible causes, such as a stress fracture or shin splints (medial tibial stress syndrome). Following the aggravating activity, the compartment is often tense, firm, painful to palpation, and very painful to passive stretch of the muscles passing through the compartment. Occasionally there is a fascial hernia present. Neurologic dysfunction is occasionally present with hypesthesia (reduced sensation) to two-point discrimination. The region of dysfunction will often guide the clinician to the affected compartment. Vascular signs associated with CECS are rare and should not be relied upon to make the diagnosis.
The most common site is the leg so the nerve roots are reviewed:
Anterior compartment
Deep peroneal nerve
Weak dorsiflexion (Lifting the toes and foot up)
First web space dysesthesia (reduced sensation or pins and needles)
Lateral compartment
Superficial peroneal nerve
Weak eversion (rolling the foot out or arch down)
Lower anterolateral shin/ dorsum or top of foot dysesthesia
Posterior compartments (superficial and deep)
Tibial and sural nerves
Weakness with plantar flexion (stand on toes)
Arch of foot dysesthesia
With a stress fracture physical examination will reveal localized tenderness to palpation, percussion, or tuning fork over the anterior tibia or lateral fibula. There may be erythema (redness) or edema over the area of tenderness. A palpable bump may indicate periosteal reaction. Patients will often have an antalgic or limping/ painful gait.
A differential includes Stress fracture, Chronic exertional compartment syndrome, Medial tibial stress syndrome ("shin splints"), Muscle-tendon injury, Complete rupture, Partial rupture, Tendinitis, Synovitis, Infection, Osteomyelitis, Cellulitis, Neurovascular condition, Phlebitis, Blood clots, Nerve entrapment, Spinal radiculopathy, Claudication, and Tumor.