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. If the pressure is present long enough, the muscle may die and amputation might be necessary.
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
- Crush injuries
- Steroid use
- 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:
- Difficulty moving the muscle
- Visible muscle bulging
How is compartment syndrome diagnosed?
First, the doctor will conduct a physical examination. He or she will check for tightness and tenderness in the muscle after exercise. If compartment syndrome is suspected, a compartment pressure measurement test will be done. To perform the test, a needle is inserted into the muscle. A machine attached to the needle will give the physician a compartment pressure reading. The number of times the needle is inserted depends on the location of the symptoms. Then the physician will have the patient run (or perform any activity that recreates the symptoms) and then retest the pressures. Compartment testing can be painful, but the discomfort typically does not persist once the test has been completed.
What is the outlook for compartment syndrome?
With prompt treatment, the outlook of compartment syndrome is promising. However, if there is a delay in diagnosis, there may be some 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. Infection is also a risk. 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. A procedure called a fasciotomy will need to take place. A fasciotomy is a surgery 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 health care provider immediately. Gradually building up your endurance may prevent chronic compartment syndrome. Wearing the right shoes may also prevent chronic compartment syndrome.
- American Academy of Orthopedic Surgeons. Compartment Syndrome. Accessed 9/19/2013.
- Oprel PP, Eversdijk MG, Vlot J, Tuinebreijer WE, Den hartog D. The acute compartment syndrome of the lower leg: a difficult diagnosis?. Open Orthop J. 2010;4(2):115-9.
- 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. www.accessmedicine.com.library.ccf.org. Accessed 9/19/2013.
- 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. www.accessmedicine.com.library.ccf.org. Accessed 9/19/2013.
- UK Ministry of Defence. Synopsis of Causation: Compartment Syndrome. Accessed 9/19/2013.
- Lyden SP, Joseph D. The clinical presentation of peripheral arterial disease and guidance for early recognition. Cleveland Clinic Journal of Medicine. 2006;73(Suppl_4):S15-S15.
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