Exertional compartment syndrome (ECS) is a condition causing pain or cramping in the legs during physical activity. This discomfort lessens with rest, posing a challenge for active individuals. While various approaches exist, surgery is a common and often effective treatment for severe or persistent symptoms. This article explores exertional compartment syndrome and what to expect if surgery becomes part of your treatment plan.
Understanding Exertional Compartment Syndrome
Exertional compartment syndrome occurs when pressure within muscle compartments builds to abnormally high levels during exercise. The legs contain groupings of muscles, blood vessels, and nerves, all encased by a thick, inelastic tissue called fascia. During activity, muscles swell, and if the fascia does not expand, the pressure inside the compartment increases. This elevated pressure can restrict blood flow, potentially leading to an inadequate supply of oxygen and nutrients to muscle and nerve cells, which can cause damage.
Individuals with ECS commonly experience tightness, cramping, numbness, or weakness in the affected limb. These symptoms arise during repetitive movements, such as running, biking, or swimming. Diagnosis often involves measuring pressure within the muscle compartments during or immediately after exercise, a procedure known as intracompartmental pressure testing.
When Surgery Becomes Necessary
Surgery, specifically a fasciotomy, is considered when conservative, non-surgical treatments have not provided sufficient relief. These initial approaches might include rest, physical therapy, activity modifications, or the use of orthotics. However, non-surgical measures often offer lasting benefit only if the activity causing the condition is significantly reduced or stopped entirely.
For individuals whose symptoms significantly hinder their activity levels or athletic performance, surgery is the most effective long-term solution. Confirmation of the diagnosis through pressure testing is performed. The decision to proceed with surgery is made when persistent pain and dysfunction outweigh the risks associated with the procedure.
The Surgical Procedure
The surgical intervention for exertional compartment syndrome is called a fasciotomy, with the primary goal of relieving pressure within the affected muscle compartments. This procedure involves cutting the inelastic fascia that encases the muscles, allowing them more room to expand during activity. The operation is performed in a hospital under general anesthesia.
The surgeon makes incisions on the skin over the affected compartments. These incisions can be small and minimally invasive, or larger, open incisions, depending on the case. Through these incisions, the fascial lining of each compartment is released, and sometimes a “window” of this tissue is removed to reduce the risk of symptom recurrence. Often, surgeons recommend releasing all affected compartments to prevent future issues.
Recovery and Potential Outcomes
Following a fasciotomy, immediate post-operative care focuses on pain management and monitoring the surgical sites. Patients are encouraged to begin moving the muscles in all compartments soon after surgery to prevent scar tissue formation. Rehabilitation is a key part of the recovery process, involving physical therapy to regain strength, flexibility, and range of motion in the treated limb.
The return to activity and sport is gradual, guided by rehabilitation progress. While surgery is effective for most in relieving symptoms, it is not without risks. Possible complications, though rare, include nerve damage, infection, numbness, bruising, scarring, or symptom recurrence. Despite these considerations, most patients experience symptom relief and return to their previous activity levels following a successful fasciotomy.