Extertional Compartment Release

In the lower leg, there are four muscle compartments. Each compartment is surrounded by a tough membrane, or fascia, which can become inflexible. When the muscles within a compartment become swollen due to strenuous exercise, the inflexible fascia can’t expand, leading to increased pressure within the compartment and subsequent pain.

Exertional compartment syndrome release, also known as fasciotomy, is a surgical procedure performed to treat chronic exertional compartment syndrome (CECS). CECS is a condition characterized by increased pressure within a muscle compartment due to exercise, causing pain and possible disability. The purpose of the fasciotomy is to relieve this pressure. The procedure involves making an incision in the skin and fascia, allowing the muscle compartment to expand and reducing the pressure.

As a fellowship trained sports surgeon, Dr. Ben Mayo has expertise in the diagnosis and treatment of chronic exertional compartment syndrome. Dr. Mayo offers comprehensive care to patients in the Detroit area with knee pain. If you are in need of an orthopedic sports surgeon, contact Dr. Ben Mayo and his team today to be seen at one of his offices in Livonia or Warren.

Candidates for this surgery are typically individuals who have been diagnosed with chronic exertional compartment syndrome and have not responded to non-surgical treatments such as physiotherapy, activity modification, or orthotics. Symptoms that might suggest CECS include recurring pain or cramping in the affected leg(s) during exercise, which subsides with rest.

The surgery for CECS, known as a fasciotomy, can be performed under general or regional anesthesia. Depending on which compartments are involved, one or more incisions will be made on your leg, over the affected muscle compartments. The tough, inflexible fascia that surrounds the muscle compartment is cut. This allows the muscles to expand without restriction, reducing the pressure inside the compartment.  The skin incision is then sutured closed. The fascia itself is left open to prevent pressure buildup in the future.

Recovery from a fasciotomy varies among individuals. You might be able to return to light, sedentary work within a couple of weeks. Return to more physical activities or sports can take several weeks to a few months. Your doctor will provide a personalized recovery plan, which will include physical therapy to restore muscle strength and functionality.

After surgery, your leg will be bandaged, and you will need crutches to avoid putting weight on it. Pain, swelling, and bruising are common but can be managed with medication. You will be given specific instructions about wound care, pain management, and when to begin moving the leg.

Often times, physical therapy is not needed after exertional compartment syndrome release. Once the incisions are well healed, you can gradually begin returning to activity.

Like all surgeries, a fasciotomy carries potential risks, which may include:

• Wound complications: due to the swelling after surgery, it is not uncommon to have wound healing issues. Normally this will resolve over time without issue. Rarely, another surgery will need to be done to prevent further issues
• Infection: As with any surgery, there’s a risk of infection, though it’s relatively rare. Antibiotics are given during surgery to minimize this risk.
• Bleeding: Excessive bleeding during or after surgery can occur but is also rare.
• Nerve damage: There’s a small risk of nerve damage, which could result in numbness, tingling, or weakness in the leg.
• Recurrence of symptoms: In some cases, the symptoms of CECS may recur even after surgery.

If left untreated, chronic exertional compartment syndrome can lead to persistent pain and disability, impacting quality of life and physical abilities. It could potentially cause permanent muscle damage due to prolonged elevated pressure in the compartment, though this is rare.