This case of a young 15-year-old high school soccer play demonstrates why chronic exertional compartment syndrome should be considered by emergency medicine physicians, coaches, trainers, therapists, and others with patients with more serious pain associated with exercise that does not cease with rest.
Abstract
Chronic exertional compartment syndrome (CECS) is a condition that commonly affects young adult athletes and often causes them to present to the emergency department. Multiple cases of chronic exertional compartment syndrome have resulted in athletes sitting out entire seasons and can lead to a career ending diagnosis.
Brief Case Description
The gold standard for diagnosing compartment syndrome using the STIC pressure monitor, provides continuous monitoring of the pressures within the compartment. This allows for continuous monitoring of the patient for up to 24 hours and can be used before or after treatment. In patients who are diagnosed with compartment syndrome and are looking to continue their competitive lifestyle of playing sports, the recommended treatment is a fasciotomy. Commonly, athletes can return to the field around 8 weeks.
This specific case including a 15-year-old female soccer player resulted in a diagnosis of compartment syndrome. She also had a fascial hernia, along with extremely high compartment pressure. While at rest and post exercise the patient had an intra-compartmental pressure of 99mmHg. The patient originally presented to the emergency department with a complaint of bilateral anterolateral leg pain during exercise that continued to increase over the years of her playing competitively. She was referred to a pediatric orthopedic clinic and was tested for compartment syndrome using the STIC pressure monitor. While at rest and post exercise the patient had an intra-compartmental pressure of 99mmHg. This is significantly higher than the recommended 30mmHg threshold. She was diagnosed with Chronic Exertional Compartment Syndrome in addition to medical tibial stress syndrome. She underwent a fasciotomy to remove the high pressures within her leg.
Intervention and Outcome Summary
The patient underwent a fasciotomy and following the treatment was advised to bear weights as tolerated and to use crutches. A fasciotomy is the gold standard for relieving compartment syndrome. Weeks after treatment she regained full range of motion and appeared neurovascularly intact. After 8 weeks the patient had significantly improved and returned to recreational running and high school soccer. It is important that compartment syndrome is considered as it commonly presents in young athletes.
Original Publication
US National Library of Medicine, National Institute of Health
Authors
James J. Bresnahan and William L. Hennrikus
