Lower Limb Chronic Exertional Compartment Syndrome: Procedural Data and Patient Demographics

Objectives: To characterize the demographics, clinical presentation, diagnostic pathways, and management of patients referred to suspected lower limb CECS, while additionally exploring clinical predictors associated with positive CPT-confirmed CECS. Chronic exertional compartment syndrome (CECS) is an important but frequently under-recognized cause of exercise-induced leg pain (EILP), commonly affecting physically active individuals and athletes. Diagnostic delays remain common due to non-specific symptoms and overlap with alternative musculoskeletal and vascular pathologies. Compartment pressure testing (CPT) remains the current reference standard investigation for CECS, although data examining predictors of positive CPT within UK specialist centers remain limited. Material and Methods: A retrospective observational study was conducted at a specialist UK National Health Service musculoskeletal center. All patients undergoing lower limb CPT for suspected CECS between June 2022 and September 2024 were included. Demographic characteristics, symptom duration, pain severity using the numerical rating scale (NRS), imaging investigations, compartment involvement, CPT findings, and management plans were retrospectively collected from electronic medical records and clinic correspondence. An exploratory univariable logistic regression analysis was performed to identify predictors of positive CPT- confirmed CECS. Results: Fifty-two patients underwent lower limb CPT during the study period. The mean age was 34.7 years, with a near-equal sex distribution. Patients experienced symptoms for a mean duration of 4.9 years prior to specialist assessment. The anterior compartment represented the most commonly involved compartment. CPT findings consistent with CECS were identified in 43 patients (82.7%). Increasing pain severity was significantly associated with positive CPT-confirmed CECS, with each one-point increase in pain NRS associated with a 2.66-fold increase in the odds of positive CPT (OR 2.662, 95% confidence intervals (CIs) 1.231–5.757; p= 0.04). Bilateral symptoms were also significantly associated with positive CPT-confirmed CECS (Odds ratios (ORs) 3.82, 95% CI 1.01–14.4; p= 0.048). Age and sex were not significantly associated with diagnostic positivity. Most patients with confirmed CECS proceeded toward consideration for surgical fasciotomy following unsuccessful conservative treatment. Conclusion: CECS remains associated with substantial diagnostic delay despite specialist referral pathways. Higher pain severity and bilateral symptom presentation were associated with increased odds of positive CPT- confirmed CECS and may represent clinically useful indicators when selecting patients for invasive diagnostic testing. Improved awareness and earlier referral pathways may help reduce delays to definitive diagnosis and treatment in patients with CECS.