The commonest examination finding associated with pain is tightness of the muscles. Firm or bulging muscles can be felt and seen in the leg/calf. Muscle hernias can be seen in 40 to 50% of the patients. There is increased pain on passive stretching of the muscles in the respective compartments. Also, there is weakness along with a pain on strength testing of the muscles, which recovers once the pain settles and the activity has been stopped for a period of time. Pain and weakness in the muscles can persist for long periods of time in later stages of CECS.
The diagnosis is further confirmed by measuring the intracompartmental pressure and using the modified Pedowitz criteria to indicate a positive test.
Criteria for positive test
Pressure more than 15 mm of Hg at rest, more than 30 mm of Hg at 1 min and more than 20 mm of Hg at 5 min after stopping the exercise.
Other diagnostic modalities as MRI, Infrared spectroscopy, Electromyography- Nerve conduction study, Ankle brachial index can be done to rule out the differential diagnosis.