In addition, it is more difficult to demonstrate, in a reproducible manner, the dynamic muscular changes on ultrasound. The inter-observer variability as well as the reduced sensitivity and specificity of ultrasound lowers diagnostic efficacy when compared to MRI. 5 Ultrasound has also been shown to be of value in the clinical work-up of patients with suspected CECS, 6 especially of the lower limbs. Over the last two decades, MRI has been shown to have a very high accuracy in confirming the diagnosis of CECS. 4Ĭonsequently, diagnostic imaging, especially MRI evaluation, is a useful tool in diagnosing CECS. The compartment pressure measurement is not standardised and there is inter-observer variability in testing which impacts decision-making with regard to proceeding to surgery. In addition, there are potential risks of infection and bleeding. The measurement is multifocal, painful, invasive and sometimes not available in some centres. 4 Ideally, measurements should be obtained before, during and after exercise. This method has been the gold standard of diagnosis of CECS however, such pressure measurements are not without challenges. Intra-compartment pressure can be measured clinically via a slit catheter or similar pressure-transducing device. Even the most experienced clinicians experience some difficulty in making this diagnosis of CECS, but with increasing awareness of this entity and availability of good-quality magnetic resonance imaging to confirm the suspicion, upper limb CECS is being more commonly diagnosed and patients more timeously managed. There is considerable overlap with the many possible causes of limb pain. In this review of the syndrome, we describe the cycle of intracellular events leading to CECS and the eventual destruction of muscle. The pathophysiology of compartment syndrome is complex. ![]() The exact prevalence is not known as many athletes modify their training methods, thus delaying or avoiding medical assistance and imaging. In addition, there is no age predilection and the syndrome may be bilateral. Although commonly noted in athletes, CECS can occur in any age group with any level of exercise activity. A high index of clinical suspicion should therefore be maintained to avoid missing the diagnosis. Much less has been reported about the upper limbs where the muscular compartments are variably noted to be involved. The term ‘chronic exertional compartment syndrome’ (CECS) (previously known as ‘anterior tibial syndrome’) refers to a condition characterised by exercise-induced pain in one or more muscle groups and is more commonly seen in the lower limbs. Exercise-related limb pain poses a management dilemma to the clinician.
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