Chronic Exertional Compartment Syndrome: A Case Report about Claudication in a Healthy Adult

Claudication occurs when the blood supply is insufficient to service the musculature in the body with oxygen and metabolic waste management. A clinical complaint of claudication is commonly seen in primary care among older patients with vascular risk factors. A young and healthy patient presenting with claudication is less common and often results in delayed diagnosis with numerous extraneous diagnostic studies. This case discusses a young, healthy male patient with lower extremity symptoms that got worse with exercise and better with rest. He had normal physical exam findings leading to multiple diagnostic studies and over 12 months between the onset of symptoms and his return to full activity. Claudication can result from rare conditions, such as chronic exertional compartment syndrome, popliteal artery entrapment syndrome, fibromuscular dysplasia, and cystic adventitial disease. Symptomatic individuals with chronic exertional compartment syndrome experience reversible muscular pain from exercise-induced pressure, which increases within the finite spaces of any muscular compartment. Understanding the pathophysiology of exertional compartment syndrome and its related diagnoses allows for an organized diagnostic approach to young, healthy patients with claudication symptoms. This organized approach allows timely care, which is imperative for primary care physicians to reduce the number of tests performed, decrease the time to diagnosis, and reduce both the anxiety and cost for the patient. The approach presented herein can serve as a reminder of a proper work-up in similar patients and allow practitioners to identify the conditions that require intervention to improve outcomes.