Chronic exertional compartment syndrome is a cause for leg pain with exercise. The usual pattern is a gradual increase in pain during continuous exercise to a point when the athlete has to stop. Pain then takes between minutes to hours to go. Patients describe a feeling of hardness or fullness in their legs, and occasionally will notice lumps in the muscles. The condition is diagnosed by performing a compartment pressure test (CPT).
During a CPT the patient must be able to reproduce their leg pain as bad as they can get it. This means that in the days to weeks before the test is done, the patient should perform moderate level exercise (and not rest) so that they can reliably reproduce their symptoms on the day of the test. The patient will also guide the Sport and Exercise Medicine (SEM) Physician as to which compartments need testing, and they must pay attention to where they develop their pain (i.e. front of the leg, side, behind the shin bone, or more than one area).
The CPT involves injecting a small amount of local anaesthetic into the skin at the sites where the pressures will be tested. The patient will then jog/run/whatever needs to be done to bring on their symptoms, usually for 10-15 minutes. They then return to the room, and the SEM Physician performs the test, which involves inserting pressure manometer needles into the relevant muscles. One special needle has a catheter inside it, and this remains in the leg while the patient does specific exercises, whilst the pressure in the leg is monitored.
The test is very safe, but complications can occur- listed below. The test takes one hour. Typically the patient can drive or fly after the test is completed.
The SEM Physician always prefers to see the patient before arranging a time for the test, to ensure the test is done correctly right the first time, reducing the risk of getting a false negative result. If the diagnosis is confirmed, then the only real treatment is surgery (a procedure called fasciotomy, performed by an orthopaedic surgeon).
Compartment pressure testing is a relatively safe procedure, but is an invasive intervention, and some complications may result including (but not limited to):
- Bleeding and bruising at the puncture sights
- Possible (permanent) damage to underlying blood vessels
- Possible (permanent) damage to underlying nerves, resulting in sensory or motor disturbance
- Failure of the procedure
- Risk of development of acute compartment syndrome requiring and urgent operation
- Risk of development of a complex regional pain syndrome
Please feel free to discuss any questions or concerns you may have with the BSEMS staff and specialists.