Concise History Taking May Aid in Distinguishing Popliteal Artery Entrapment From Chronic Exertional Compartment Syndrome

Background: Young individuals with exercise-induced lower leg pain (ELP) may occasionally have rare entities such as functional popliteal artery entrapment syndrome (fPAES) or deep posterior chronic exertional compartment syndrome (dp-CECS). Diagnostic gold standards are absent for these syndromes, which share common symptoms like pain, tightness, and cramps, leading to significant treatment delays. Purpose: To determine whether the severity and frequency of typical symptoms in fPAES and dp-CECS are different. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Between January 2013 and February 2024, frequency and severity of leg pain, tightness, cramps, muscle weakness, and foot paresthesias were scored using a 5-point Likert scale (not severe, mild, moderate, severe, or very severe and never, sometimes, half of the time, most of the time, or all of the time) at rest and during exercise in patients with fPAES or dp-CECS before and after invasive therapy (surgery or botulinum toxin-A injection for fPAES, fasciotomy for dp-CECS). Only patients with fPAES and dp-CECS who reported success (cure or substantial relief) following a tailored treatment were studied. Nonnormally distributed data were presented as median (range or IQR), and normally distributed data were presented as mean ± SE. Nominal variables were compared using the χ 2 test, and ordinal and continuous variables were compared with Mann-Whitney U tests. Binomial logistic regression was used to evaluate associations between fPAES or dp-CECS and symptom scores at rest and during exercise (95% confidence interval). Results: Data of 69 patients were available for analysis (fPAES, n = 24; dp-CECS, n = 45). Frequency and severity of pain, cramps, and muscle weakness were not different between groups. However, high foot paresthesias scores at rest ( P = .009; odds ratio [OR], 1.17; 95% CI, 1.04-1.32) and during exercise ( P = .008; OR, 1.193; 95% CI, 1.05-1.36) were associated with fPAES. Conversely, high tightness scores during rest pointed toward dp-CECS ( P = .003; OR, 0.801; 95% CI, 0.69-0.93). Bilateral complaints were more common in fPAES (92%) compared to dp-CECS (40%; P = .001). Conclusion: Our study showed that patients who reported success after tailored treatment showed that standardized history taking may aid in distinguishing patients with exercise-induced lower leg pain due to fPAES from those with dp-CECS.