Ultrasound-Guided Percutaneous Fasciotomy of Three Compartments of the Leg for Chronic Exertional Compartment Syndrome in a High-Performance Contemporary Dancer: A Case Report

Abstract

Abstract

Chronic exertional compartment syndrome (CECS) is a frequently underdiagnosed cause of exercise-induced leg pain that is activity-dependent. We present the case of a 20-year-old female, high-performance contemporary dancer with an approximately three-year history of progressive leg pain refractory to an exhaustive multimodal conservative treatment including NSAIDs, neuromodulators, physiotherapy with myofascial release, and botulinum toxin infiltration of three compartments. Complementary diagnostic studies including musculoskeletal Doppler ultrasound, magnetic resonance imaging (MRI), and electrodiagnostic studies yielded negative results, consistent with the dynamic nature of the condition. Based on the pathognomonic symptom pattern, imaging evolution, exclusion of neurological and vascular etiologies, and lack of results with conservative measures, a presumptive clinical diagnosis of multi-compartment CECS was established after exclusion of alternative diagnoses. In November 2025, the patient underwent ultrasound-guided percutaneous fasciotomy of the anterior, lateral, and superficial posterior compartments of the left leg via three minimally invasive incisions under regional anesthesia and sedation. Intraoperative reduction of compartmental tension was directly observed following each fascial release. A minor wound dehiscence resolved without further intervention. Serial visual analog scale (VAS) scores demonstrated progressive pain resolution (preoperative 9/10, three weeks 4/10, six weeks 3/10, three months 2/10, and six months 2/10), with a successful return-to-dance program protocol at final follow-up returning to old performance levels. This case highlights the diagnostic challenges of CECS in athletes, the limitations of conservative measures, and the technical feasibility of a simultaneous three-compartment ultrasound-guided percutaneous fasciotomy as a safe, effective, and minimally invasive solution.