Management for chronic exertional compartment syndrome

Note: The only nonsurgical management that has been shown to be effective in chronic exertional compartment syndrome is cessation of the inciting activity.

Discuss the natural history of chronic exertional pain syndrome with the patient, including their concerns, goals and expectations, and a proposed management plan including self-management.

Initial management for chronic exertional compartment syndrome is nonsurgical.

The only nonsurgical management that has been shown to be effective in chronic exertional compartment syndrome is cessation of the inciting activity.

Simple analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), may provide short-term pain relief in chronic exertional compartment syndrome. Most often, simple analgesics are not required as cessation of the inciting activity leads to resolution of the pain. If analgesia is required, see Analgesia for soft-tissue limb conditions.

A number of other nonsurgical treatments exist, such as stretching, massage, taping, botulinum toxin A injections, chemodenervation, ultrasound-guided fascial fenestration, and biomechanical assessment and correction; however, none of these have high-certainty evidence to support themRajasekaran, 2016.

If cessation of the inciting activity is not acceptable, surgical management (fasciotomy) may be consideredDing, 2020. Refer the patient to a surgeon for advice.