Bilateral Exertional Compartment Syndrome With Endoscopic Fasciotomy Surgical Intervention in a High School Athlete

A 17-year-old female presented to the physical therapy clinic with bilateral lower leg pain that worsened with activity. The patient experienced numbness, tingling, and cramping along the lateral and posterior portions of her legs during basketball practice, and her symptoms had gradually worsened over the past eight months. She obtained minimal relief with conservative treatments such as stretching and rest. X-rays and MRI of the lower limbs were obtained six months after symptoms began and were unremarkable. Further evaluation included compartment pressure testing taken before and after exercise. The patient demonstrated diagnostic pressures indicative of compartment syndrome in two compartments bilaterally. The patient was subsequently diagnosed with exertional compartment syndrome. Exertional compartment syndrome is a cause of muscle pain that occurs due to increased tissue pressure within the confinement of the closed fascial space during exercise. Patients are often misdiagnosed or there is a significant delay in the correct diagnosis. The gold standard for diagnosis is measurement of intracompartmental pressures with the Stryker catheter. Clinicians should consider exertional compartment syndrome in active patients who present with generalized muscle pain or sensation deficits that worsen with activity and are relieved with rest. Surgical intervention is a reasonable intervention and the only definitive option for an athlete with chronic exertional compartment syndrome who wants to continue high-level competition. Endoscopic fasciotomies are the new preferred techniques compared to more invasive open surgeries, which require a full incision. Endoscopic fasciotomy has a quicker healing time and has been shown to be as effective at relieving compartment syndrome symptoms as invasive open techniques. After surgical intervention, the patient reported a 90% reduction in symptoms and had returned to full sport participation within two months.