Chronic compartment syndrome in the posterior thigh

Anatomy: The thigh muscles are divided into three groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias); a front, an inner and a rear muscle compartment (Drawing).

Cause: The muscles can increase so quickly following intensive training that the muscle membranes surrounding the muscles cannot keep up, causing the pressure in the muscle compartment to increase. The pressure can in some cases increase so greatly that impingement of blood vessels and nerves can occur. In other cases, chronic muscle compartment syndrome can arise as a complication to earlier muscle ruptures.

Symptoms: With chronic compartment syndrome there is slowly insetting pain in the posterior muscles after a few minutes activity. There is a sensation that the muscle is “tightened” and becomes hard, which is accompanied by discomfort. If the activity is stopped the discomfort diminishes, but returns after a short period of resuming the sports activity once again.

Examination: The diagnosis is made on the basis of the characteristic history and possibly with a pressure measurement in the muscle compartment (article).

Treatment: With chronic muscle compartment syndrome the treatment primarily comprises relief and slowly increasing training intensity, rheumatic medicine (NSAID), and massage (article 1). If there is scar tissue in the muscle, ultrasound guided injection of corticosteroid around the scar tissue formation can be attempted. In cases where there is a lack of progress a surgical splitting of the muscle membranes can be performed, which is usually a minor procedure with good results (article-1) (article-2).

Rehabilitation: Once the pain has diminished, the sports activity can generally be slowly resumed according to the principles mentioned under rehabilitation, general.

Complications: In cases of lack of progress with relief and slow rehabilitation, an ultrasound scan should be performed before possible surgery to rule out complications to (previous) muscle ruptures. If scar tissue is in evidence in the muscles, ultrasound guided injection of corticosteroid can be attempted in the area surrounding the scar tissue.