Delayed Diagnosis to Definitive Treatment: Diagnostic Delay and Outcomes After Endoscopic-Assisted Fasciotomy for Chronic Exertional Compartment Syndrome.

BACKGROUND: Chronic exertional compartment syndrome (CECS) is an often-overlooked cause of exertional lower leg pain that is frequently misdiagnosed. Overlapping symptoms and inconsistent diagnostic approaches may delay diagnosis and prolong morbidity. The purpose of this study was to characterize the diagnostic journey of patients ultimately treated surgically for CECS and to report postoperative outcomes. METHODS: A retrospective chart review was performed following IRB approval. Patients diagnosed with CECS and treated operatively by the senior author between 2020 and 2025 were identified using Current Procedural Terminology (CPT), International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes. Demographics, symptom duration, prior diagnostic workup, operative details, and postoperative outcomes were collected. Median follow-up was 42 weeks (range, 15-184 weeks). Descriptive statistics were reported. RESULTS: Thirteen patients met inclusion criteria (mean age, 27.3 years; mean BMI, 28.3). Mean symptom duration prior to definitive diagnosis was 51.5 months, and bilateral symptoms were present in 12 patients. Most patients underwent extensive diagnostic testing and multiple unsuccessful conservative treatment strategies before referral. All patients underwent endoscopic-assisted anterolateral compartment release, with open posterior compartment fasciotomy performed when clinically indicated. Nine patients underwent bilateral procedures. At final follow-up, all patients reported symptomatic improvement and return to baseline activity. Four patients required additional evaluation for persistent posterior compartment symptoms, and 2 ultimately underwent further posterior compartment release. There were no intraoperative complications. CONCLUSION: CECS remains a frequently delayed diagnosis because of nonspecific symptoms, substantial overlap with other causes of exertional lower-leg pain, and limitations of currently available diagnostic tools. Although the effect of diagnostic delay on postoperative outcomes could not be directly assessed, prolonged delays were associated with substantial diagnostic burden and management complexity. Following fasciotomy, all patients reported symptomatic improvement and return to baseline activity. Greater awareness of CECS and a structured diagnostic approach may help facilitate earlier recognition and treatment. LEVEL OF EVIDENCE: Level IV, retrospective case series.