Diagnosis and management of chronic compartment syndrome

Background. This article describes the diagnosis and management of chronic compartment syndrome and functional popliteal entrapment syndrome, unusual causes for claudication in young adults. Methods. A total of 276 patients (<50 years old) with isolated muscle cramping, swelling, and plantar paresthesia were routinely evaluated with compartment pressures (normal <15 mm Hg), stress plethysmography, and selectively evaluated with pulse volume recordings and arteriography. Results. Patients were young (mean 28.4 years) with long-standing symptoms (mean 24 months), affecting 1 or both lower extremities (32% vs 68%, respectively). Of the patients, 84 were male (30%) and 192 were female (70%). Common symptoms were isolated muscle cramping (100%) or swelling (40%), and plantar paresthesia (20%). Of 436 treated compartments, 316 were, anterolateral, 70 deep-posterior, and 50 superficial-posterior. Mean compartment pressure was 28 mm Hg. Resting pulse volume recordings were abnormal in 6 patients (2.5%); 82 had positive popliteal entrapment tests (30%), but symptoms were present in only 21 (9.7%). Open fasciectomy was performed in all patients with chronic compartment syndrome or functional entrapment. Local anesthesia was used in 243 (88%) and general in 33 patients (12%). Mean follow-up was 60 months. Of the 276 patients, 92% had Full relief of symptoms and returned to normal daily or athletic activity. Eight percent obtained symptomatic relief, but activity was limited because of new compartment symptoms or other orthopedic injury. Conclusions. Open fasciectomy for chronic compartment and functional entrapment syndromes is effective therapy.