A 22 year old professional soccer player from Europe presents to the Medical Center complaining of anterior (medical lingo: Front) shin pain. Patient states he was fine until 3 months ago when the pain started.

He only has the pain when he runs and after he is done running. Pain typically subsides within 2 hours after rest. His past medical history is unremarkable, his physical exams, X-Rays and MRI are completely normal. On exam patient has no point tenderness and any discomfort.




Discussion:

Due to the fact that patients typically present with a normal examination as well as non-impressive diagnostic findings Diagnosis is usually overlooked: Chronic exertional compartment syndrome may prove a challenge to detect, and acute compartment syndrome may require immediate surgical intervention. The cause is described as when a muscle becomes too big for the sheath that surrounds it causing pain.

The enlarged muscle blocks the flow of blood producing ischemia which in turns produces pain. The large muscle on the outside of the shin area is called the tibialis anterior and is surrounded by a sheath. This is called the anterior compartment of the lower leg. Over use of this muscle causes swelling, the compartment most often involved is the anterior.

Lateral compartment is also a common place for involvement of overuse. Usually, a patient with chronic exertional compartment syndrome has no symptoms at rest. Compartment pressures may remain elevated for up to 40-60 minutes after exercise.