Compartment Syndrome

What is compartment syndrome?

Compartment syndrome happens when there’s too much pressure around your muscles. The pressure restricts (reduces) the flow of blood, fresh oxygen and nutrients to your muscles and nerves. Compartment syndrome is extremely painful.

A “compartment” is the medical term for a group of muscles, nerves and blood vessels. Compartments are covered by a fascia — a thin, firm membrane. Compartment syndrome happens when extra pressure builds up inside a compartment and your muscles press against the fascia more than they should.

Compartment syndrome can happen to any muscle group, but it’s most common in your:

• Legs, especially your lower legs.
• Arms, including your hands and wrists.
• Feet.
• Abdomen (belly).
• Buttocks (butt).

Types of compartment syndrome

There are two types of compartment syndrome:

• Acute compartment syndrome: Acute compartment syndrome happens suddenly (usually after a severe injury). It’s a medical emergency. Go to the emergency room right away if you think you have acute compartment syndrome. If it’s not treated immediately, acute compartment syndrome can cause permanent muscle damage, paralysis or death.
• Chronic compartment syndrome: Chronic (long-term) compartment syndrome typically builds up slowly over time, especially after intense physical activities or exercise. Chronic compartment syndrome usually isn’t an emergency, but it can still be extremely painful. Healthcare providers sometimes call it exertional compartment syndrome.

How common is compartment syndrome?

Experts estimate that fewer than 10 in every 100,000 people in the U.S. experience acute compartment syndrome each year. However, it’s much more common in people who have some types of bone fractures (broken bones). For example, studies estimate that around 10% of people who break their tibia (shin bone) develop compartment syndrome.

What are the signs and symptoms of compartment syndrome?

The most common signs and symptoms of compartment syndrome include:

• Visible bulging or swelling around a muscle.
• Muscle pain (more severe than the usual soreness you’d feel after intense activity).
• Tightness.
• Severe pain when stretching.
• Numbness.
• Tingling or a burning feeling under your skin (paresthesia).
• Feeling like your muscle is fuller, firmer or bigger than usual.

What is the main cause of compartment syndrome?

Compartment syndrome happens when an injury or repeated stress causes swelling and bleeding inside a muscle compartment. If the pressure builds too much, your muscles press against the fascia that holds them in place.

The fascia has some natural ability to stretch and expand, but not much. If pressure keeps building in the compartment, the fascia eventually runs out of room and starts squeezing against your muscles and nerves. This squeezing is what causes pain and other symptoms.

If you’ve ever worn a pair of shoes that’s a size or two too small, you’ve probably experienced a similar buildup of pressure. Early in the day, your feet may fit comfortably in the shoes. But as the day goes on and you walk and move, your feet naturally start to swell. By the end of the day, those shoes that felt “fine enough” in the morning may feel like they’re vice grips on your feet. Compartment syndrome is much more dangerous because that kind of pressure happens inside your body.

What causes compartment syndrome depends on which type you have.

Acute compartment syndrome causes

Severe injuries are the most common cause of acute compartment syndrome, including:

• Car accidents.
• Falling from a high place (like off a roof or ladder).
• Bone fractures (broken bones).
• Crushing injuries (when something heavy falls on you).
• Severe muscle contusions.
• Sports injuries.
• Complications after surgery.
• Complications from wearing a cast or splint that’s too tight.
• Prolonged pressure on an arm or leg after not moving for several hours at a time.

Chronic compartment syndrome causes

Chronic (exertional) compartment syndrome usually builds up over time. Frequent, intense exercise is the most common cause. Doing the same kind of workout or training can put repeated stress on the same muscles and cause a pressure build-up. Some common causes include:

• Running.
• Biking.
• Swimming.
• Weightlifting.

It’s less common, but doing a repetitive motion at work or for a hobby can also cause chronic compartment syndrome.

What are the risk factors?

Anyone can develop acute compartment syndrome because it happens after sudden injuries.

Athletes and people with physically demanding jobs are more likely to overtrain or overwork their muscles and develop chronic compartment syndrome.

People with hemophilia and other types of blood disorders may have an increased risk.

What are compartment syndrome complications?

Compartment syndrome can cause serious complications.

If the pressure in a muscle compartment gets too high, your tissues won’t get enough fresh blood, oxygen and nutrients. This can lead to tissue death (necrosis), which causes permanent damage.

Acute compartment syndrome can be fatal if it’s not treated right away. Go to the emergency room if you think you have acute compartment syndrome.

How do providers diagnose compartment syndrome?

A healthcare provider will diagnose compartment syndrome with a physical exam and tests. They’ll examine your muscles and the area around them. They might first rule out other issues (like tendinitis or shin splints) that can cause similar symptoms.

Tell your provider what you were doing when you first noticed pain and other symptoms. Tell them if certain activities seem to make your symptoms better or worse.

Compartment syndrome tests

Your provider may use a few tests to diagnose compartment syndrome, including:

• X-ray: An X-ray will help rule out bone fractures and other injuries.
• Compartment pressure measurement test: Your provider will insert a needle into a few different places in your muscle compartment. A machine attached to the needle will read the pressure inside your body. This test might be painful. Tell your provider how much it hurts when they insert the needle, and if any places hurt more than others.
• Repeat pressure test: If your provider thinks you have chronic compartment syndrome, they may repeat a compartment pressure test after you exercise. They’ll compare the results to the pressure levels before you exercised.

What are compartment syndrome treatments?

How providers treat compartment syndrome depends on which type you have.

Acute compartment syndrome is a medical emergency that needs immediate surgery. Chronic compartment syndrome usually gets better after you tweak your exercise habits or routine.

Acute compartment syndrome treatment

A surgeon will perform an operation called a fasciotomy. They’ll make an incision (cut) through your skin and fascia to relieve the pressure in your affected muscle compartment.

They’ll close the incision after the swelling and pressure go away. Sometimes, that can’t happen immediately. Your surgeon may do a skin graft, taking skin from another area of your body to cover the incision.

Chronic compartment syndrome treatment

Chronic (exertional) compartment syndrome usually gets better and goes away if you rest your affected muscle compartments and avoid overusing them in the future. Your provider will suggest treatments to manage your symptoms and prevent pressure buildup, including:

• Medications: Anti-inflammatory medications like over-the-counter NSAIDs or acetaminophen reduce inflammation and relieve pain. Don’t take these medications for more than 10 days in a row without talking to your provider.
• Changing your exercise routine: You might need to try different, lower-impact exercises. Some people with compartment syndrome switch to cross-training. Cross-training is mixing up which type of exercise you do instead of working out the same way or with the same activity each time. You might also have to change where you exercise — running on a softer track instead of concrete, for example.
• Physical therapy: A physical therapist will help you increase strength and flexibility in your affected muscles. They’ll also show you ways to modify your exercises to prevent stress and pressure buildup.
• Orthotics: Orthotics are shoe inserts that support your feet and legs. They might help people with compartment syndrome in their legs. Your provider will tell you which type of orthotics will work best.

You may need a fasciotomy if other treatments don’t work or the compartment syndrome comes back (recurs). Your provider will let you know when you should consider surgery and what to expect.

How soon after treatment will I feel better?

If you have acute compartment syndrome, you should feel better after you’ve recovered from the fasciotomy. Most people need to rest for around a month before using those muscles. Your surgeon will tell you when it’s safe to start moving again, and how long you should wait before resuming physical activities.

Managing chronic compartment syndrome may take longer, especially at first. It might take a few months to find a combination of treatments and exercise modifications that manage your symptoms. Your symptoms should improve gradually as you find ways to avoid putting too much pressure on your affected muscles.

How can I prevent compartment syndrome?

You can’t prevent acute compartment syndrome because it happens suddenly after an injury, or as a complication you can’t predict. Going to the emergency room as soon as you think you have acute compartment syndrome is the only way to prevent severe complications.

Tell your provider if you have a cast or splint that feels too tight — especially if you’ve taken pain medication and that part of your body still hurts or swells. Your provider can adjust your immobilization device to prevent compartment syndrome.

Avoiding putting too much stress on your muscles is the best way to prevent chronic compartment syndrome. Follow these tips to reduce your risk:

• Avoid overtraining — don’t “play through pain” if your muscles hurt during or after physical activity.
• Stretch and warm up before working out. Cool down and stretch after intense activity.
• Build your endurance gradually — don’t suddenly ramp up the intensity of your workouts.
• Mix up your workouts. Try to avoid doing the same workout, in the same way, every time you train.
• Try to avoid exercising on hard, rigid surfaces like concrete or tile floors.

What can I expect if I have compartment syndrome?

Compartment syndrome can be very painful, but your symptoms should improve when you start managing them.

Acute compartment syndrome usually doesn’t come back (recur) once it’s treated with a fasciotomy. But it’s critical to get it diagnosed and treated as soon as possible. Your risk of permanent damage increases the longer you have untreated acute compartment syndrome.

Chronic compartment syndrome may come back, especially if you suddenly ramp up your activity level. Ask your provider which kinds of activities are safe to do while recovering.

It can take up to a year before you can safely resume intense physical activity.

How do you know if someone has compartment syndrome?

Only a healthcare provider can diagnose compartment syndrome, but don’t ignore symptoms like muscle pain or swelling. Go to the emergency room if you think there’s a chance you might have acute compartment syndrome.

Visit a healthcare provider if you notice pain or swelling after exercise, especially if it happens often. Chronic compartment syndrome isn’t a life-threatening emergency, but it’s still serious.

People sometimes think of the saying, “No pain, no gain,” but that mantra couldn’t be further from the truth. You shouldn’t be in agony after working out or being active. There’s a difference between feeling satisfyingly sore a day or two after a big workout and not being able to move without feeling intense pain.

Visit a healthcare provider if you’re ever so sore that you’re worried something might be wrong. Even if you don’t have chronic compartment syndrome, you might have another injury or issue that’s causing symptoms.

What questions should I ask my provider?

• Which type of compartment syndrome do I have?
• Which treatments will I need?
• Will I need surgery?
• How should I change my workout routine?
• When can I resume physical activities?