Unilateral Exertional Compartment Syndrome in a Pediatric Competitive Figure Skater

Chronic exertional compartment syndrome (CECS) occurs when there is an increase in interstitial pressure within a non-compliant fascial compartment during exercise. The hallmark sign of CECS is a consistent onset of symptoms at a specific time, distance or intensity of activity followed by resolution of symptoms when the activity is stopped. Chronic exertional compartment syndrome commonly occurs in the lower legs, is bilateral 85% to 95% of the time and occurs most often in running athletes. The purpose of this case report is to describe the clinical presentation of unilateral chronic exertional compartment syndrome in a pediatric athlete that did not present with the hallmark signs for CECS and additionally participates in a sport where CECS is not common. The subject is a 13 year old female competitive figure skater who presented to physical therapy with right calf pain when figure skating and performing functional tasks. During the initial evaluation the patient had pain at rest as well as with objective testing of the right lower leg. The patient did not progress as expected in physical therapy and therefore the differential diagnosis was re-visited and additional measures were performed. The patient was re-diagnosed with unilateral chronic exertional compartment syndrome. The diagnosis was first clinical and later confirmed by intracompartmental testing. This case report illustrates a patient diagnosed with CECS by intra-compartmental pressure testing that did not present with the standard signs and symptoms; she did not participate in a sport where CECS is typically seen and her symptoms were unilateral. This report represents the importance of consistently including CECS in the differential diagnosis of lower leg pain in athletes regardless of the initial presentation and the sport in which they participate. Additionally, it highlights the importance of a detailed subjective history and the significance of aggravating and alleviating factors in relation to training.