Current Diagnosis and Management of Chronic Exertional Compartment Syndrome

Purpose of Review: The goal of this paper is to review the current evidence on diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg. We sought to answer the question of whether recent research and innovations have demonstrated diagnostic alternatives or adjuncts to intramuscular compartment pressure testing and whether there are effective treatment options other than surgical fasciotomy. Recent Findings: Research has shown promising outcomes with non-operative management including targeted alterations to running biomechanics. There is also research demonstrating efficacy in the use of botulinum injection as well as ultrasound-guided fascial fenestration and fasciotomy. Summary: Innovations in the diagnosis of CECS include the use of continuous compartment pressure monitoring during exercise as well as some early research on the use of musculoskeletal ultrasound and particular MRI protocols of the lower leg. Non-surgical management includes intervention to improve running biomechanics, botulinum toxin injection, and ultrasound-guided fasciotomy. Future research is needed on alternative diagnostic modalities including musculoskeletal ultrasound and exercise MRI protocols and on alternative management strategies including botulinum toxin injection and ultrasound-guided fascial fenestration or fasciotomy.