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Chronic exertional compartment syndrome

William P Meehan, III, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


First described by Mavor in 1956 [1], chronic exertional compartment syndrome (CECS) is an overuse injury that typically affects young endurance athletes, especially those who run extensively. Like acute compartment syndrome, it is thought to result from increased pressure within the confines of the osteofascial planes of a muscle compartment. CECS occurs primarily in the lower leg, although it has been reported in the upper extremity and elsewhere in the body [2].

The presentation, diagnosis, and management of chronic exertional compartment syndrome are reviewed here. Acute compartment syndrome is discussed separately. (See "Acute compartment syndrome of the extremities".)


The true prevalence of chronic exertional compartment syndrome (CECS) in the general population is unknown [3]. It is likely that many people suffering from early symptoms of CECS decrease or modify their activity level to manage their condition and never seek medical attention. In addition, CECS is likely under-diagnosed by the coaches, athletic trainers, and primary care physicians to whom symptoms are first presented [4]. The gold standard for diagnosis requires invasive pressure measurements in the affected muscle compartment, something rarely done in training rooms or primary care clinics.

Observational studies provide some sense of the prevalence of CECS among certain populations:

A retrospective study of active Unites States military personnel reported 4100 cases of CECS between 2006 and 2011, for an incidence rate of 0.49 cases per 1000 person-years [5]. Age was the most significant risk factor with the adjusted incidence rate ratio for personnel over 40 years almost nine times that of personnel under 20 years (IRR 8.77; 95% CI 7.31-10.52). Further study is needed to determine whether comparable results would be found in a civilian adult running population.

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Literature review current through: Nov 2017. | This topic last updated: Mar 07, 2016.
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