What is compartment syndrome?
Compartment syndrome is a painful condition that occurs when too much pressure is built up within and between muscles. It can damage muscles and nerves and lead to decreased blood flow. There are two types of compartment syndrome: acute and chronic.
Thick bands of tissue called fascia divide groups of muscles in the arms and
legs. Within each fascia there is a compartment, or opening. The opening
contains muscle tissue, nerves, and blood vessels. When swelling starts in the
openings, it causes the fascia to push up against the muscles. The swelling can
become so bad that blood flow is blocked and cannot reach the muscles, nerves,
or blood vessels within the arms and legs, leading to permanent damage.
What causes compartment syndrome?
Acute compartment syndrome
Acute compartment syndrome typically causes immediate swelling and pain to the area.
Severe trauma such as a car crash
A badly bruised muscle
Bandaging or casting that is wrapped too tightly
Chronic compartment syndrome
Chronic compartment syndrome is caused by exercise and repetitive movements. The front of the lower leg is the most common area for the pain and swelling of chronic compartment syndrome to occur. It is commonly found in athletes who run a lot. It is also found among swimmers and cyclists and other athletes who repeat motions. The pain is usually relieved by discontinuing the exercise.
What are the symptoms of compartment syndrome?
Acute compartment syndrome symptoms include:
More pain than expected from an injury
Severe pain when the muscle is stretched
A tingling or burning feeling in the skin
A tight or full feeling in the muscle
Numbness or paralysis (This usually does not happen at the start.)
Chronic compartment syndrome symptoms include:
Visible muscle bulging
Tightness when palpating (feeling) the muscle
How is compartment syndrome diagnosed?
First, the doctor conducts a physical examination. He or she checks for tightness and tenderness in the muscle at rest and possibly after exercise.
If compartment syndrome is suspected, a compartment pressure measurement test is done. To perform the test, the doctor inserts a needle into the muscle. A machine attached to the needle gives a compartment pressure reading. The number of times the needle is inserted depends on the location of the symptoms.
The doctor then has the patient run (or perform any activity that recreates the symptoms) and retests the pressures. Compartment testing can be painful, but the discomfort typically goes away once the test is completed.
What is the outlook for compartment syndrome?
With prompt treatment, the outlook for compartment syndrome is promising. However, if there is a delay in diagnosis, there may be complications. Permanent nerve damage can occur after just 12 to 24 hours of compression in acute compartment syndrome.
What are the complications of compartment syndrome?
If acute compartment syndrome is not diagnosed initially, permanent injuries to nerves and muscles can occur. Contractures or amputation may be required if the condition is not taken care of immediately. Chronic compartment syndrome can result in nerve and muscle damage as well, but less often than the acute form.
How is compartment syndrome treated?
Acute compartment syndrome
Acute compartment syndrome is a medical emergency. Surgery is required with a procedure called a fasciotomy, in which an incision is made into the skin and fascia that covers the affected compartment. When the swelling decreases, the incision will be repaired. Sometimes the incision cannot be closed immediately, so a skin graft may be necessary.
Chronic compartment syndrome
Symptoms may go away when the physical activity that causes the pain comes to an end. Cross-training and low-impact activities are suggested. For some people, symptoms are worse on certain surfaces, so changing surfaces may also help reduce the pain. Physical therapy, orthotics, and anti-inflammatory medicines may also help. If these practices do not help, surgery is an option. Doctors use a procedure similar to the fasciotomy surgery that treats acute compartment syndrome, but the incision is much shorter. Surgery for chronic compartment syndrome is not an emergency.
Can compartment syndrome be prevented?
For acute compartment syndrome, early diagnosis and treatment can prevent further complications, but there is no definite way to prevent it. People with casts should be aware that if pain and swelling increases even after taking medication, they should see their healthcare provider immediately. Gradually building up your endurance may prevent chronic compartment syndrome. Wearing the right shoes, altering gait pattern in runners, and improving flexibility may also prevent or decrease the severity of chronic compartment syndrome.
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Raukar NP, Raukar GJ, Savitt DL. Chapter 11. Extremity Trauma. In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds. The Atlas of Emergency Medicine. 3rd ed. New York: McGraw-Hill; 2010.
Smith WR, Agudelo JF, Parekh A, Shank JR. Chapter 3. Musculoskeletal Trauma Surgery. In: Skinner HB, ed. CURRENT Diagnosis & Treatment in Orthopedics. 4th ed. New York: McGraw-Hill; 2006.
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