Chronic Exertional Compartment Syndrome in Athletes

J Hand Surg Am. 2017 Nov;42(11):917-923. doi: 10.1016/j.jhsa.2017.09.009.


Chronic exertional compartment syndrome (CECS) refers to exercise-induced, reversible increases in pressure within well-defined inelastic fascial compartments leading to compromised tissue perfusion followed by functional loss, ischemic pain, and neurologic symptoms. Symptoms typically resolve when the activity ceases and there are usually no permanent sequelae. In the upper extremity, this condition most commonly affects athletes during sports requiring repetitive and vigorous gripping, such as rowers. In addition to clinical history and examination, a number of methods aid diagnosis, including compartment pressure measurements, magnetic resonance imaging, and near infrared spectroscopy. When symptoms persist despite conservative treatment, multiple operative techniques have been described to treat CECS including open, mini-open, and endoscopic release of involved compartments. We review the pathophysiology, diagnostic modalities, treatment strategies, and outcomes data for CECS of the upper extremity while highlighting areas of residual controversy.

Keywords: Athlete; chronic exertional compartment syndrome; fasciotomy; peripheral nerve; upper extremity.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Compartment Syndromes / diagnostic imaging
  • Compartment Syndromes / etiology*
  • Compartment Syndromes / surgery*
  • Cumulative Trauma Disorders / complications*
  • Decompression, Surgical / methods*
  • Elbow / physiopathology
  • Elbow / surgery
  • Fasciotomy / methods
  • Female
  • Forearm / physiopathology
  • Forearm / surgery
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Physical Exertion*
  • Prognosis
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome