Exertional Compartment Syndrome

Exertional compartment syndrome is often a diagnosis of exclusion and occurs secondary to increased pressures in a muscular compartment, with resultant ischemia manifesting most commonly as pain.  There are two distinct forms of exertional compartment syndrome, acute and chronic types.  Chronic exertional compartment syndrome (CECS) occurs in the setting of recurrent, reversible ischemic episodes following the cessation of activity resulting in the predictable decrease in fascial compartment pressures. Although benign, the refractory nature of CECS often results in a substantial portion of patients ultimately electing to proceed with fasciotomies. Acute exertional compartment syndrome (AECS) is a rare entity that, unfortunately, its diagnosis is often delayed.  Just as in acute compartment syndrome (ACS), the diagnosis implies a surgical emergency requiring fasciotomies to help mitigate the risks of ensuing irreversible muscle ischemia and neurovascular injury, which can occur after just a few hours alone.  ECS typically occurs in the lower leg but can also occur in other areas like the forearm, thigh, or hand. The article provides an overview of the hallmarks and diagnostic considerations surrounding both forms of ECS, including the importance of clinicians maintaining a high index of suspicion to avoid delays in diagnosis.