Working Diagnosis:
After consultation with Neurology and Pain Management to exclude other possible etiologies, it was determined that Ms. X likely has recurrent chronic exertional compartment syndrome.

Treatment:
Ms. X was recommended multiple conservative treatment modalities including anodyne/infrared therapy in the training room, activity modification during swimming, and a topical cream. Activity modification helped somewhat but anodyne and the cream did not. She did not tolerate gabapentin due to side effects. Patient was referred to Ortho or a right leg revision four-compartment fasciotomy.

Outcome:
Patient was followed by Sports Medicine and Ortho after unilateral compartment release surgery. She was cleared to return to swimming and told to modify and reduce activity if symptoms return. If symptoms continue to persist on the contralateral side, the patient will be referred for revision with Orthopedic Surgery on that side as well.

Author's Comments:
Exertional compartment syndrome is most commonly seen in young adult athletes who participate in repetitive impact sports, such as running. It is characterized by a consistent onset after certain distance or time of activity and worsens with sustained performance. Unlike in traumatic compartment syndrome, the symptoms improve and dissipate after stopping the offending activity. Treatment for exertional compartment syndrome is a fasciotomy, or surgical compartment release. This surgery has 80 percent effectiveness in the anterior compartment, the most commonly affected compartment. This case is unique in that the anterior compartment was uninvolved and the symptoms returned after fasciotomy.

References:
1. Sravya Vajapey & Timothy L. Miller (2017) Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature, The Physician and Sportsmedicine, 45:4, 391-398, DOI:10.1080/00913847.2017.1384289

2. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome [Updated 2020 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan.

3. . Tucker AK. Chronic exertional compartment syndrome of the leg. Curr Rev Musculoskeletal Med. 2010; 3(1-4):32-37. Published 2010 Sep 2. doi:10.1007/s12178-010-9065-4

4. Waterman BR, Laughlin M, Kilcoyne K, Cameron KL, Owens BD. Surgical treatment of chronic exertional compartment syndrome of the leg: failure rates and postoperative disability in an active patient population. J Bone Joint Surg Am. 2013;95(7):592-596. doi:10.2106/JBJS.L.00481

5. Winkes M, van Eerten P, Scheltinga M. Deep posterior chronic exertional compartment syndrome as a cause of leg pain. Tiefes, posteriores chronisches belastungsinduziertes Kompartmentsyndrom als Ursache von Beinschmerz. Unfallchirurg. 2020;123(Suppl 1):3-7. doi:10.1007/s00113-019-0665-1

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