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Chronic Leg Pain in A Division II Field Hockey Player: A Case Report

August 17, 2020

Clinical Cases

Persistent and recurrent symptoms of leg pain, cramping, and tightness in any athlete should raise awareness of underlying chronic exertional compartment syndrome (CECS) and warrant early intra-compartmental pressure measurements using a STIC pressure monitor for an effective diagnosis.

Abstract

Chronic exertional compartment syndrome in athletes commonly represents a diagnostic and management challenge for clinicians. A lack of measuring pressure measurements for use in proper decision making, can complicate early recognition of compartment syndrome and may lead to a missed diagnosis. Therefore, a timely diagnosis for compartment syndrome, is critical. The purpose of this case report is to retrospectively explore the clinical presentation and decision-making process during care of an athlete eventually determined to have chronic exertional compartment syndrome.

Brief Case Description

This case discusses an 18-year-old Division II student athlete on a women’s field hockey team that was experiencing bilateral chronic leg pain. The subject reported an approximate 3-year history of lower leg symptoms that included a dull ache, cramping, and commonly anything involving running elevated the pain. After visiting the orthopedic surgeon, and sports medicine specialists, the subject was diagnosed with “shin splints” or medial tibial stress syndrome. The subject reported no pain at rest, but her leg pain became increasingly worse with any physical activity. The subject was then tested using the Gold Standard STIC pressure monitor, used to aid in diagnosing CECS through the evaluation of intra-compartmental pressure measurements (ICP). Once ICP testing was completed, it developed a clear diagnosis of compartment syndrome. The subject underwent an immediate fasciotomy. A surgical fasciotomy for CECS has a high success rate and is consistent with the favorable results obtained in athletes.

Intervention and Outcome Summary

Overuse related leg pain is a frequent problem seen in recreational and competitive athletes and can be challenging to diagnose. This often concludes in a missed or delayed diagnosis. A diagnosis of exertional compartmental syndrome is commonly made with a thorough history and physical examination. To provide the most accurate diagnosis of chronic exertional compartment syndrome, it is recommended to be done using a STIC intra-compartmental pressure monitor. Using the STIC pressure monitor to aid in the diagnosis of compartment syndrome eliminated a missed diagnosis and potential nerve damage or loss of a limb for the athlete.

Original Publication:

International Journal of Sports Physical Therapy

Authors:

Julie Snowden, PT, MHS, OCS, Jonathan A. Becker, MD, Jr. Joseph A. Brosky, PT, DHS, SCS, and Charles Hazle, PhD, PT

 
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