Chronic Exertional Compartment Syndrome and Release
Patient Selection
Chronic exertional compartment syndrome (CECS) most common in athletes
Symptoms
Pain after certain duration or intensity of exercise
Most common bilaterally
No inciting event
Asymptomatic except during activity
Pathophysiology
Unclear
Likely relative ischemia, when muscles cannot expand because of tight fascia during exercise
Most common in anterior compartment
Confirm diagnosis by measuring compartment pressures before and after exercising
1-minute postexercise greater than 30 mm Hg
5-minute postexercise greater than 20 mm Hg
Postexercise level is greater than preexercise level by 15 mm Hg
No imaging necessary
Compartment release contraindicated if pressures do not confirm CECS
Procedure
Anterior and Lateral Compartments
 | Video 95.1 Fasciotomy: Two-Incision Technique. Mary Lloyd Ireland, MD (2 min) |
Figure 1Illustration shows skin markings for the two-incision technique for anterior and lateral compartment release.
Figure 2Intraoperative photographs show the two-incision technique for anterior and lateral compartment releases. A, The superficial peroneal nerve is visualized in the distal lateral incision. B, The intermuscular raphe is seen between the fascial incisions. C, Fasciotomy is performed using long Metzenbaum scissors in a push-cut fashion. The nerve is visualized directly and protected in the distal incision.
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