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Practice Easily Missed?

Chronic exertional compartment syndrome

BMJ 2013; 346 doi: (Published 15 January 2013) Cite this as: BMJ 2013;346:f33

This article has a correction. Please see:

  1. Ronald S Paik, orthopedic resident,
  2. Douglas Pepples, primary care sports fellow,
  3. Mark R Hutchinson, professor of orthopedics and sports medicine
  1. 1Sports Medicine Service, University of Illinois at Chicago, Chicago, IL 60612, USA
  1. Correspondence to: M R Hutchinson mhutch{at}

A 31 year old woman with no medical history of note presented with bilateral lower leg pain on running. The pain was absent when she started running; gradually built after the first kilometer, forcing her to stop; then resolved shortly after stopping. She tried not running for several weeks, but the pain returned when she started again. Physical examination at rest was normal, with no swelling or focal tenderness. The differential diagnosis included muscle strain, medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome (CECS), and popliteal artery entrapment syndrome. Dynamic intracompartmental pressure measurements confirmed the diagnosis of CECS.

  • How common is CECS?

  • Prevalence depends on the population studied

  • Runners and endurance athletes have a higher risk than sedentary populations or those who engage in upper extremity dominant sports.1 In a prospective study of exercise active people (not formally defined as athletes) who had exercise induced leg pain, 49% were diagnosed as having the syndrome.2 In a case series of athletes with exercise induced leg pain, the incidence of pressure confirmed CECS was 27%3

  • People with diabetes may be at increased risk, even with minimal exertional activity2

  • Prevalence is similar in men and women, and median age of onset is about 20 years4

What is CECS?

CECS is an ischaemic condition that occurs when a fascial compartment is unable to accommodate the increase in volume associated with muscle contraction and swelling. The increased volume increases intracompartmental pressure and reduces perfusion of the tissues within the fascial compartment. The condition is most common in the lower leg but has also been described in the thigh, forearm (gymnasts and climbers), and foot (runners and during aerobic training). Symptoms depend on the fascial compartment affected and the nerve or structures contained within (figure).

Cross sectional anatomy of the …

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