A competitive cyclist develops increasing tightness and cramping pain over the anterolateral right leg that appears at a reproducible point every training session and is accompanied by numbness on the dorsum of the first web space. Symptoms settle completely within 20 minutes of stopping. Conservative measures including gait adjustment have failed. What is the most appropriate next step?

• A Nerve conduction study of the common peroneal nerve
• B MRI of the tibia to exclude a longitudinal stress fracture
• C Measure intracompartmental pressure before and immediately after exercise ✓
• D Radionuclide bone scan to exclude a stress reaction

Explanation

Chronic exertional compartment syndrome is diagnosed objectively by intracompartmental pressure measurement using Pedowitz criteria: resting pressure above 15 mmHg, pressure above 30 mmHg within one minute of exercise, above 20 mmHg at five minutes, or a rise greater than 10 mmHg over the pre-exercise value. Paraesthesia over the first web space suggests deep peroneal nerve involvement within the anterior compartment. When conservative treatment fails, fasciotomy of the affected compartments is curative; imaging studies cannot confirm the diagnosis.

Reference: DeLee and Drez's Orthopaedic Sports Medicine, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.