Chronic exertional compartment syndrome testing: a minimalist approach

Intracompartmental pressure testing is considered the ‘gold standard’ for investigating chronic exertional compartment syndrome (CECS) and is the primary investigation used to decide on whether to proceed with surgical intervention. It involves getting patients to reproduce their symptoms of exercise-related pain,1 and then inserting a pressure manometer into the symptomatic compartment and recording the intracompartmental pressure. To date, a universal protocol has not been adopted for compartment pressure testing and much debate exists as to the ‘right way to do it’. The physiology of compartment pressure measurements is complex and spurious compartment pressure measurements are likely to result unless the water manometer or pressure transducer is inserted in parallel to muscle fibres and away from the musculotendinous junction.2 Thus, the anterior compartment alone lends itself easily to measurement. Normative values for resting and exercise pressures for each of the four lower leg muscle …