Title: Bilateral Chronic Exertional Compartment Syndrome in a Division I Field Hockey Athlete: A Case Study
Name: Ashley Lambert
Primary Presenters: Ashley Lambert, ATS
College of Health Sciences
Masters
Faculty Sponsor(s): Hayley Ericksen, PhD, ATC

Bilateral Exertional Compartment Syndrome in a Division I Field Hockey Athlete: A Case Study

Ashley Lambert*, Jillian Rubin†, Hayley Ericksen*
*University of Wisconsin-Milwaukee † Northwestern University

Background: A collegiate field hockey athlete, with no previous history of injury, presented with soreness, achiness, and tightness in her lower legs following activity. Her symptoms included swelling, expanding, and burning sensations into her shins. These signs and symptoms are associated with chronic exertional compartment syndrome (CECS) caused by high volumes of repetitive, exertional loading.

Differential Diagnoses: Bilateral anterior shin pain, medial tibial stress syndrome, CECS, peroneal entrapment, fibromyalgia, chronic regional pain syndrome

Treatment: Conservative management helped to manage pain, tightness, and overall discomfort. Compartment testing confirmed bilateral CECS in three of the four compartments of the lower leg. Several physician consultations occurred including x-rays and MRIs, with no new conclusions and minimal improvement in symptoms leading to bilateral 3-compartment fasciotomies. After surgery and rehabilitation, the patient was able to participate with modifications. The athletic trainer and coaching staff tracked the patient’s mileage and cardiac activity, which allowed the patient to participate in limited capacities.

Uniqueness: Division I athletics require higher volumes and greater intensity of training and practice. Field hockey demands a forward torso position, dorsiflexion, and anteriorly stressed body position during sport, which likely increased pressure on the lower legs. This condition is unique in that multiple compartments of the lower leg are affected.

Conclusions: CECS can be managed at high competition levels but can be complicated by sport demands, severity, and the aspirations to continue physically demanding participation. This case can be considered sport specific as the athletic position in field hockey creates large increases in stress to the lower extremities. Proper treatment can help to manage the condition but may not completely resolve pain or limitations. It is important to apply previous CECS research to this patient and others in similar situations to improve treatment outcomes.

https://sites.uwm.edu/healthresearchsymposium/files/formidable/2/Lambert-A-3MT-References-1.pdf