Disclosures: Tam Bui, DO: No financial relationships or conflicts of interest

Case Diagnosis: 26-year-old male with persistent chronic exertional compartment syndrome (CECS) refractory to compartment release.

Case Description: 1-year post bilateral anterolateral compartment release, the patient endorsed persistent symptoms including bilateral leg pain at the anterior compartments and scar sites, ¼ of a mile into running. He also noted exertion-dependent foot-drop with toe-drag at 1 mile. He had received ultrasound-guided Botox injections to his anterolateral compartments, and scar hydro-dissections at the entrapment points of his superficial peroneal nerves, as diagnosed on ultrasound. The patient experienced minimal improvement with these interventions. At 18 months post-op, he received his first perineural injection therapy (PIT) treatment. A mixture of lidocaine with D5W was prepared to achieve 1 mg/cc, which was then injected along his tibial, saphenous, and sural nerves. His scar on the left was hydro-dissected. Treatment was repeated on days 5, 14, and 22 (right leg only).

Setting: Tertiary care military hospitalAssessment/

Results: Immediately after his first treatment, he ran 0.92 miles before experiencing symptoms of scar tightness on his right leg and no pain on the left. On a subsequent run, he noticed symptoms at 0.3 miles with worsening at 1 mile requiring him to stop. After the second treatment, on the right side, he had pain at 0.5 miles and foot drop at 1.5 miles with no pain on the left. There was no change in symptoms after his third session. On his 4th, he ran right after the session and had to stop at the 1-mile mark due to fatigue and only endorsed minimal right leg pressure.

Discussion: Perineural Injection Therapy and careful scar hydro-dissection for CECS refractory to surgery can lead to significant improvement in pain and function.

Conclusion: The symptoms of CECS may be due to chronic irritation of cutaneous nerves, and these patients may benefit from treatment with PIT.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/perineural-injection-therapy-for-chronic-exertional-compartment-syndrome-refractory-to-compartment-release-a-case-report/