Unilateral Exertional Compartment Syndrome in a Pediatric Competitive Figure Skater
January 27, 2021
It is recommended to consistently included compartment syndrome in the differential diagnosis of lower leg pain and the measurement of compartment pressures to ensure the proper diagnosis and treatment which will create greater ease in returning the athlete to competition.
This case represents the importance of consistently including Chronic Exertional Compartment Syndrome (CECS) in the assessment of lower leg pain in athletes, regardless of the initial presentation. CECS commonly occurs in the lower legs, is bilateral 85% to 95% of the time, and occurs most often in running athletes. This case, however, demonstrates when a pediatric athlete did not present the hallmark signs, nor did she participate in a sport where CECS is common.
Brief Case Description
A 13-year-old female competitive figure skater originally presented to physical therapy with right calf pain that had started about two months prior. She trained on the ice for 2-3 hours per day and spent at least one hour of additional time doing strength and conditioning, pilates, or ballet. Her initial therapy included wearing a walking boot for three weeks and progress back into skating. When the pain never fully resolved and then intensified after returning to training, she was instructed to wear the walking boot for another three weeks and halt all training. After five and a half months since her initial report of pain, her patient evaluation data showed a consistent increase in symptoms that now led to suspicion of exertional compartment syndrome. She was referred to a physician who did intra-compartmental pressure testing and found that she tested positive for Compartment Syndrome in all four compartments of her right leg. The patient’s CECS diagnosis was not officially made until 8 months following her initial symptoms.
Intervention and Outcome Summary
CECS diagnosis is difficult and often delayed, making it important to have a comprehensive differential diagnosis at the time of the initial evaluation as well as consistently including CECS as a possibility with any lower leg pain, particularly in athletes. Regardless of the initial presentation and the sport in which they participate in, early suspicion and testing could improve the high incidence in the delay in diagnosis of chronic exertional compartment syndrome.
Alexandra M Patterson Tichy, and Chris Bradley