1028 - Successful Treatment of Chronic Exertional Compartment Syndrome with Hydrodissection & Prolotherapy

Case Diagnosis: Chronic posterior exertional compartment syndrome, myofascial pain

Case Description: 17-year-old female high school soccer player with a 3-year history of chronic exertional compartment syndrome (CECS) of bilateral calves presented to clinic for non-operative treatment options. Chief complaints included right lower extremity paresthesia and pain that progressively worsened preventing her from playing soccer. Ankle brachial indices during exercise were abnormal on the right (1.03 - > 0.69) and borderline on the left (1.08- > 0.96). Previous treatment included physical therapy, cupping, dry needling, and therapeutic exercise with no reported improvement in symptoms. She decided to pursue treatment with dextrose prolotherapy treatment.

A mixture of 10cc 1% lidocaine and 10cc 50% dextrose created 25% dextrose concentration. Ultrasound guidance was used to identify and inject intramuscular fascial abnormalities in bilateral medial and lateral gastrocnemius muscles. Total of 5 treatments, 4 weeks apart fully resolved symptoms. At 20 weeks, successfully returned to 75-80 minutes of play without limitations or adverse symptoms.

Discussions: CECS can persist during exercise if left untreated. A fasciotomy of the involved compartments is considered standard treatment for cases that do not improve. Reported outcomes of surgical interventions vary widely, and success rates rarely exceed 90%.

For cases that do not improve with non-operative treatment, an ultrasound-guided fascial hydrodissection with prolotherapy can be considered. A fascial hydrodissection is a novel approach to addressing fascial-related pain, and may be beneficial for treatment of CECS. Further research should investigate further potential etiologies of CECS and consider fascial hydrodissections and prolotherapy as a treatment plan.

Conclusions: Our case report identified a novel non-surgical treatment option in patients with moderate to severe CECS. Further research is needed to identify the mechanism and efficacy of fascial hydrodissection and prolotherapy in the management of CECS.