Definition and Overview

Compartment syndrome is an orthopaedic condition that occurs when the pressure within the muscles becomes elevated and rises to dangerous levels. This can obstruct blood flow to the affected area, which means that the muscles will have an inadequate supply of oxygen and nutrients. When this happens, patients are at risk of suffering from permanent cell damage and tissue necrosis. When not treated promptly and properly, the condition can lead to permanent disability.

The syndrome affects compartments, or groups of nerves, muscles, and blood vessels in the body. The compartments are covered with fascia, a tough membrane that keeps the tissues in their proper place.

Compartment syndrome, which can either be chronic or acute, can cause severe pain. Acute cases are considered medical emergencies and require immediate surgical intervention to prevent lasting damage to the affected muscles.

The condition is sometimes also called anterior compartment syndrome because it usually affects the anterior compartment of the calf. However, it can also affect the feet, hands, arms, buttocks, and even the abdomen.

Causes of Condition

Compartment syndrome occurs when there is bleeding or swelling within a compartment. Since the fascia is unable to stretch or expand, this causes the pressure within the capillaries, nerves, and muscles to rise.

In the case of acute compartment syndrome, the cause of bleeding and swelling are usually severe traumatic injuries that result in fractures (broken bones) and bruised muscles. The condition may also occur due to other factors, such as:

  • Anabolic steroid use

  • The use of constricting bandages or plaster casts

  • When blood flow is re-established following a blockage

  • Burns, which causes skin to become tight due to scarring

Chronic compartment syndrome, on the other hand, is most often caused by long-term exertion or strain, usually due to sports such as biking, running, and swimming, among others. It may also occur gradually over a long period due to repetitive activity. In addition, it does not often cause permanent disability and is not as dangerous as acute cases. The problem also goes away without treatment when the activity that caused it is discontinued.

Although it is not quite common, abdominal compartment syndrome may also occur usually due to severe abdominal trauma. Like acute compartment syndrome, it also has to be treated immediately because it can reduce the blood supply to the abdominal organs. Without sufficient blood flow, the patient will be at risk of life-threatening conditions, such as renal and gastrointestinal malfunction as well as multi-organ failure.

Key Symptoms

Signs and symptoms of acute compartment syndrome include:

  • Intense pain, which worsens when the affected muscles are used

  • Tingling

  • Burning sensation or paresthesia

  • Tightness or fullness in the muscles

  • Numbness and paralysis, which are indicative of an impending permanent tissue injury

On the other hand, chronic compartment syndrome is characterised by:

  • Numbness

  • Difficulty moving the affected body part

  • Visible bulging of muscles

  • Pain that subsides when activities or exercise is discontinued

  • Cramping

For athletes and active individuals who experience the above symptoms due to their regular sports activities, it is important that they consult a doctor in order to rule out other possible causes of their symptoms. To do so, doctors usually order an X-ray to check for fractures and other possible problems.

If none are found, the doctor will measure the pressure in the affected muscle compartment both before and after exercise or activity. If the pressure remains high following certain activities, the diagnosis would be chronic compartment syndrome.

Who to See and Types of Treatments Available

Acute and chronic cases of compartment syndrome are treated differently. The former, which is considered a medical emergency, is treated with a surgical procedure called fasciotomy, which is performed by making an incision in the skin and fascia that covers the affected compartment. Its goal is to release the pressure to relieve the patient’s symptoms. However, if the swelling is severe, it may be difficult or impossible to close the incision following surgery. Thus, it is usually only repaired once the swelling improves. In some cases, this may require a skin grafting procedure.

On the other hand, chronic compartment syndrome can be managed with non-surgical treatments, which include the following:

However, the best way to relieve the symptoms is to stop the activity that causes it. If this is not possible, patients, such as professional athletes, can also undergo surgery. This option is also recommended for patients whose condition does not respond to conventional treatment methods. Surgical treatment for chronic compartment syndrome involves opening the fascia with the goal to provide the affected muscles a room to swell and expand. This requires a smaller incision compared to the surgical procedure used to treat acute compartment syndrome.

References:

  • Raza H, Mahapatra A. “Acute compartment syndrome in orthopedics: causes, diagnosis, and management.” Advances in Orthopedics. Volume 2015. https://www.hindawi.com/journals/aorth/2015/543412/

  • Via AG, Oliva F, Spoliti M, Maffulli N. “Acute compartment syndrome.” Muscles Ligaments Tendons J. 2015 Jan-Mar; 5(1): 18-22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396671/

  • Smith JS. “Compartment syndrome.” Journal of the American Academy of Physician Assistants. 2013. 26(9): 48-49. http://journals.lww.com/jaapa/Citation/2013/09000/Compartment_syndrome.10.aspx

  • Hutchinson M. “Chronic exertional compartment syndrome.” British Journal of Sports Medicine. http://bjsm.bmj.com/content/45/12/952

  • Tucker AK. “Chronic exertional compartment syndrome of the leg.” Curr Rev Musculoskelet Med. 2010 Oct; 3(1-4): 32-37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941579/

Share This Information: