Exercise-Associated Acute Compartment Syndrome: Early Diagnosis, Intracompartmental Pressure Assessment, and Prevention of Irreversible Muscle Injury

Resumen

Acute exertional compartment syndrome is an uncommon but time-sensitive musculoskeletal emergency that may develop after intense or unfamiliar physical activity and can result in irreversible muscular and neurological injury when diagnosis is delayed. This study analyzed the available evidence regarding early clinical recognition, intracompartmental pressure assessment, exercise-related muscle injury, differential diagnosis, emergency management, and prevention of permanent tissue damage. A structured integrative review based on the Scientific Method was conducted using clinical reviews, diagnostic studies, case series, systematic reviews, and relevant reports related to acute compartment syndrome, exertional compartment syndrome, rhabdomyolysis, intracompartmental pressure, and fasciotomy. The findings showed that isolated clinical manifestations have limited sensitivity and that serial examination is essential in patients with persistent or progressive post-exertional pain. Continuous intracompartmental pressure monitoring has demonstrated high diagnostic performance in selected acute compartment syndrome populations, particularly when interpreted using differential pressure rather than absolute pressure alone. Evidence from young athletes with acute exertional compartment syndrome also revealed frequent neurological abnormalities, delayed diagnosis, and persistent functional deficits in a subset of patients. Differential diagnosis is especially important because chronic exertional compartment syndrome, exertional rhabdomyolysis, and uncomplicated post-exercise muscle injury may initially present with overlapping symptoms. However, persistent worsening pain, compartment tension, focal neurological changes, and objective evidence of reduced compartment perfusion increase suspicion of an acute ischemic process. Early recognition, repeated clinical evaluation, appropriate pressure assessment, urgent orthopedic evaluation, and timely fasciotomy when indicated remain the principal measures for limiting irreversible neuromuscular injury. Preventive strategies should additionally include progressive training adaptation, adequate recovery, hydration, recognition of excessive exertional stress, and education regarding warning symptoms that exceed expected post-exercise discomfort.