Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Solberg, Julie

Keywords

chronic exertional compartment syndrome (CECS), conservative care, conservative treatment, fasciotomy, surgical treatment

Abstract

Chronic exertional compartment syndrome (CECS) is a relatively rare pathology characterized by pain, tightness, and/or numbness in the affected calf upon performance of repetitive physical activity, most commonly with running or serving in the military. CECS usually has a delay in diagnosis due to low levels of awareness among clinicians and a wide range of differential diagnoses for chronic exertional leg pain. The natural course of CECS is often not self-limiting and therefore requires intervention, as symptoms can be severely debilitating and eventually force patients to avoid any provoking activity. The purpose of this literature review is to take a closer look at both conservative and surgical management of CECS and compare which has greater effectiveness in treating and relieving the symptoms associated with this chronic condition. Search databases were used including PubMed, ClinicalKey, and SportDiscuss. Literature was deemed inclusive if the study focused on and evaluated treatment options of CECS, specifically fasciotomy or conservative care measures. Reference articles were thoroughly examined and chosen based on the ability to fit beneath one of three themes: decreased pain, patient satisfaction, and/or return to activity. All searches were narrowed to the past 25 years. Overall, this literature review revealed the success of fasciotomy as a treatment option in patients with CECS. It showed that surgical intervention made a significant difference in pain level, patient satisfaction, and return to activity in patients as opposed to conservative care. It would be beneficial to utilize prospective randomized controlled trials in future studies to help with some of the noted study limitations, including overall small sample size, disproportionate sample size between surgical and conservative groups, and higher initial ICP values in surgically treated patients versus conservatively treated.

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