[Chronic exertional compartment syndrome - an overlooked diagnosis of exercise related leg pain]

Chronic exertional compartment syndrome (CECS) is an underdiagnosed clinical condition primarily affecting young, physically active people between the ages of 15 and 25. Pathophysiologically, there is an activity associated pressure increase in one or more muscle compartments of the lower leg, usually triggered by sports including running or jumping. The lower legs are most affected, but compartment syndromes of arms, thighs, feet and even the paravertebral muscles have also been described. Typically, CECS manifests as bilateral exercise related leg pain, quickly subsiding after the end of activity. Intracompartmental pressure measurement is required to make a definitive diagnosis. Vascular entrapments, spinal pathologies and myopathies should be considered in the differential diagnosis. Conservative therapy measures include activity modifications, detonation of the muscles, gait retraining, optimization of biomechanics, compression stockings, dry needling and Botulinum toxin injections. If symptoms persist, an endoscopically assisted fasciotomy is a surgical procedure with few complications and a high success rate.