Chronic exertional compartment syndrome has symptoms similar to those of the acute entity but to a lesser degree and is a more difficult diagnosis to make. Patients typically complain of aching pain or paresthesias (and occasionally vascular complaints) after exercises that stress or challenge the leg muscles.25 Runners complain of insidious pain that begins to limit their activity level. Symptoms originate after beginning activity, and typically resolve after 10 to 30 minutes upon completing the activity. Symptoms most commonly occur in the anterior and lateral compartments. Anterior compartment symptoms include paresthesias in the first web space. Recent studies outlining vascular flow as well as MRI findings in exertional compartment
Figure 64-3 A, Anterolateral incision for decompression of the anterior and lateral compartments. B, Posteromedial incision for decompression of the superficial and deep posterior compartments. (From Mubarak SJ, Owen CA: Double-incision fasciotomy of the leg for decompression in compartment syndromes. J Bone Joint Surg Am 1977;59:184-187.)
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syndrome have been used to noninvasively evaluate this syndrome. Pre- and postexercise MRI changes in blood flow or fluid in the involved area have been documented, but results of MRI in diagnosing this entity have been equivocal. Invasive catheter measurements for significant increases in pressure postexercise have also been used.26 This is more invasive but currently more reliable and reproducible. After the diagnosis has been made, for symptoms that are significant and recalcitrant to conservative care, release of the involved (typically the anterolateral) compartments has been described. This can be done using a large or small open24 approach as previously described or a percutaneous endoscopic approach.27 This includes three small skin incisions and subcutaneous evaluation of the fascia with use of an endoscope to delineate the intermuscular septum and the fascia anteriorly and posteriorly for release (Fig. 64-4).27 This minimizes the invasiveness with regard to the skin incisions and has been reported to have satisfactory success (approximately 90%). Return to play is typically in a few weeks.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.