Peripheral arterial disease (PAD) and chronic exertional compartment syndrome (CECS) both cause exercise-induced lower limb pain. CECS is mostly described in young individuals and may therefore not be considered in older patients with intermittent claudication (IC). The aim of our study was to identify differences in characteristics and symptomatology between patients with CECS and PAD that may help in recognizing CECS in patients ≥50 years with exercise induced lower limb pain.
In this case-control study, CECS patients ≥50 years were selected from a prospectively followed cohort and compared with a sample of newly diagnosed PAD patients ≥50 years. A questionnaire assessed frequency and severity of lower limb pain, tightness, cramps, muscle weakness and altered skin sensation at rest and exercise.
At rest, CECS patients (n=43, 42% female, 57 years, range 50-76) reported significantly more pain, tightness, muscle weakness and altered lower limb skin sensation (all p<0.01) than PAD patients (n=41, 39% female, 72 years, range 51-93). Having CECS was associated with a significantly higher combined symptom score at rest (p=0.02). During exercise, CECS patients experienced more tightness, muscle weakness and altered sensation (p<0.01) but not pain and cramps (p=0.36, p=0.70). Exercise induced complaints occurred much later in CECS patients than in PAD patients (15 vs 4 minutes, p<0.01). Persistence of pain over 4.5 minutes proved most discriminative for the presence of CECS (sensitivity 95%, specificity 54%, PPV 65%). Exercise cessation completely alleviated complaints in all PAD patients (n=41) but not in 73% (n=29) of the CECS patients. Ongoing discomfort strongly predicted the presence of CECS (sensitivity 73%, specificity 100%, PPV 100%).
CECS patients ≥50 years report a symptom pattern that is different from patients with PAD. These differences may aid vascular surgeons in identifying older patients with CECS.

Copyright © 2020. Published by Elsevier Inc.