Patients with Exercise-Induced Leg Pain – A Retrospective Study of 730 Patients with Suspected Chronic Exertional Compartment Syndrome

Abstract

Background Exercise-Induced Leg Pain (EILP) is common in the athletic population. The pain is elicited by exercise and relieved by rest. The differential diagnosis is broad, and the main differential diagnoses are: medial tibial stress syndrome, chronic exertional compartment syndrome, stress fracture, nerve entrapments, and popliteal arterial entrapment syndrome. Chronic exertional compartment syndrome (CECS) is the second most common diagnose of EILP, caused by abnormally elevated intramuscular pressure. It is an underdiagnosed cause of leg pain with long average symptom duration. Aim To investigate characteristics of a large group of patients with EILP including age, gender, BMI, symptom duration, experienced pain intensity, pain locations, sport participation and training volume before and after symptoms started, and profession. Furthermore, the aims were to define the diagnoses in this patient population, to analyze characteristics of a large group of patients with CECS, and to identify differences between the patients with CECS and the patients with other causes of leg pain. Method This study is a retrospective review of 730 patients admitted to the Dept. of Orthopaedics, Sahlgrenska University Hospital, between the years of 2010 and 2016. All patients had EILP and were suspected to have CECS on clinical grounds. All the patients completed a questionnaire and a patient pain drawing. The patients indicated the afflicted areas of pain on the drawing. Results The average age of the EILP-patients was 26 years (range 9-80), 23 years in females and 32 years in males. Females represented 56.4%. The average symptom duration was 27 months (range 1- 4 600). Patients’ participation in sports or exercise was 95% before onset of symptoms and was 78% in current situation. The most common diagnosis was found to be CECS in 41.6% of the EILP-patients. Co-morbidity with other leg-related conditions was defined in 34% of the CECS-patients. The average age of the CECS-patients was lower than in patients with pain of other causes, 27 years (SD 11.7) and 33 years (SD 16.2) respectively (p-value=0.000). Conclusion Patients with EILP are young, active and have a long pain duration. Many of the patients continue exercising after onset of pain, but in other forms. The most common diagnosis in this population is CECS. Co-morbidity is common in CECS-patients, reported in a third of the CECS-patients. Patients with CECS are younger than patients with pain of other causes.