| Chronic | |||
| Exertional | |||
| Compartment | |||
| Syndrome | |||
History
Patients often present with pain that is described as cramping, burning, and/or tightness in the affected compartment. It is furthur described as constant during or for several minutes after exercise. By definition the pain is associated with exertion. It usually begins after a consistent amount of exertional time, although this may be progressively shorter over the course of the disorder. If the patient attempts to 'work through the pain', he/she will develop progressively increasing pain as exercise continues. Pain typically declines and then ceases over several minutes following a period of rest, although severe forms of CECS pain continue producing mild pain through the night. It is exceedingly rare for an CECS to progress into an acute compartment syndrome, albeit possible. Often the patient will report a recent increase in training time or intensity. The pain should not be present upon the first steps taken as would be present with a stress fracture.
Subjectively, with lateral or anterior CECS, the pain is felt over the anterolateral portion of the shin with occasional radiation into the ankle or foot. The superficial posterior compartment radiates pain into the mid to upper calf, whereas the deep posterior compartment CECS is felt over the medial shin and/or distal calf and the arch of the foot. Variability is noted in the occurrence of pareshesias (tingling-pins and needles) associated with CECS. Typically symptoms are bilateral with one side more severe than the other. Patients reporting chronic leg pain will rarely provide all the information necessary to arrive at a proper diagnosis without careful guidance and focused questions. Frequently, an athlete will have minimal symptoms or clinical signs at the time of the evaluation. For this reason it is imperative to obtain a thorough history. A focal, isolated site of pain along a muscle-tendon unit (commonly at the musculotendinous junction) frequently indicates a strain or partial rupture, and on the bone one must consider a stress fracture. Pain along the entire shin is more likely from periostitis or medial tibial stress syndrome ("shin splints"). Pain involving an entire muscle group could stem from a contusion, myositis, CECS, infection, blood clot, or other neurovascular disorder.