A Complex Case of Refractory Exertional Compartment Syndrome With Fibular Neuropathy in an Athlete

ABSTRACT: Calf pain can result from various causes, including rare conditions such as common peroneal nerve entrapment (CPNE) and chronic exertional compartment syndrome (CECS), both requiring careful evaluation for accurate diagnosis. We present a rare case of leg pain caused by concurrent CPNE and CECS in a middle-aged recreational athlete with a history of bilateral popliteal fasciotomies. We hypothesized that fasciotomy scar tissue decreased compartmental mechanical compliance, transiently increasing intracompartmental pressure. Ultrasound imaging and electrodiagnostic testing confirmed bilateral common peroneal neuropathies. After bilateral peroneal nerve decompression, the patient's left leg pain resolved, but he continued to experience residual right calf pain. A selective motor tibial nerve block with hydrodissection provided temporary symptom relief, leading to a diagnosis of CECS. This case underscores the complexity of leg pain in athletes, arising from two concomitant conditions, and demonstrates the use of a selective motor block as a diagnostic tool for CECS.