Compartment syndrome is a painful and sometimes serious medical condition in which excessive pressure builds up within a muscle compartment, impeding the blood flow to the tissues in the affected area thus depriving them of necessary oxygen (ischemia). Compartment syndrome occurs most commonly in the front muscle compartment of the calf, but can also present in the arms, hands, feet, and buttocks. Compartment syndrome often occurs after an injury and can be classified as acute or chronic, depending on the cause.
Acute compartment syndrome is considered a medical emergency and usually presents shortly after an accident or fracture, while chronic (also called exertional) compartment syndrome may take days or weeks to develop and is generally associated with physical exertion or exercise. If left untreated, compartment syndrome can result in severe tissue damage, loss of body function, cellular death (necrosis), or amputation.
How Compartment Syndrome Occurs
Muscles, blood vessels, and nerves are organized into groupings called compartments that are covered by walls of tough connective tissues (fascia). The fascia’s job is to keep the tissues in place within each compartment, therefore, the membrane does not easily stretch or expand.
When an injury occurs, fluid from inflammation (edema) or blood can accumulate inside a compartment which creates increased pressure on the tissues in that compartment, as well as decreased blood flow. Without adequate blood flow, these affected tissues can be damaged quickly.
Diagnosing Compartment Syndrome
While a physical examination and evaluation of symptoms may be sufficient to diagnose compartment syndrome, the only method to achieve a definitive diagnosis is through direct pressure measurement. Compartment pressure is measured by inserting a needle (which is attached to a pressure monitor) into the affected area. Measurements may be assessed while the patient performs an activity that precipitates the pain and again after the activity to compare pressure levels in the compartment.
Acute Compartment Syndrome
Acute compartment syndrome, which is the most common type, is usually caused by a fractured arm or leg, and the pressure almost always develops rapidly. Acute compartment syndrome can, however, also appear later, after the fracture is treated with casting or surgery.
Other injuries or factors that can contribute to acute compartment syndrome include:
- Constrictive or overly tight bandaging or casting
- Crush injuries
- Compression of a limb for a prolonged period
- Severely bruised muscle, such as from a vehicular accident or contact sports injury
- Blood clot in the arm or leg
- Surgery involving blocking a blood vessel in an extremity
- Anabolic steroid use
- Heavy alcohol or drug use
Symptoms of acute compartment syndrome can include:
- Sudden, persistent aching in a leg or arm (often worsening when the limb is stretched)
- Pain that seems more severe than the injury warrants
- Tightness, swelling, and bruising of the affected area
- Tingling and/or burning (paresthesia) in the limb
- Numbness or paralysis in the limb (may indicate permanent damage)
Treating Acute Compartment Syndrome
Most patients experiencing acute compartment syndrome require immediate surgery to alleviate the compartment pressure. Relieving pressure from acute compartment syndrome involves the surgeon cutting through the fascia of the affected compartment in a procedure called a fasciotomy. In some cases, the surgical site must be left open until the swelling reduces. Skin grafting may also be utilized.
After a fasciotomy, recovery may include:
- Elevation of the affected limb
- Cold therapy
- Pain and anti-coagulation medication
- Wound management
- Physical therapy to regain muscle strength and range of motion
- Temporary limitations on physical activities
Your surgeon will give you detailed instructions for your postoperative care.
Chronic Compartment Syndrome
Chronic, also called exertional, compartment syndrome is typically not an emergency, as in acute compartment syndrome. The pressure within the compartment usually develops over a period of days or weeks, often due to overexertion during rigorous exercise. Chronic compartment syndrome most commonly affects the lower leg, thigh, or buttock and presents within approximately 30 minutes after beginning strenuous activity.
Chronic compartment syndrome symptoms include pain and/or cramping during exercise (especially activity involving repetitive motion) and is often mistaken for shin splints due to symptom similarity. The pain typically subsides upon stopping the activity.
Other possible symptoms of chronic compartment symptoms include:
- Numbness, tightness, tingling, or weakness in the affected limb
- Difficulty moving the limb
- Bulge in the muscle (muscle hernia)
Common activities that may contribute to chronic or exertional compartment syndrome are:
- Intense and/or frequent workouts
Other possible factors thought to be involved in developing chronic compartment syndrome include:
- Enlarged muscles
- Overly inflexible or thick fascia around the compartment
- Venous hypertension (pressure in the veins)
If you are experiencing symptoms of chronic compartment syndrome, you should discontinue the activity causing the pain. Continuing to exercise through the pain can cause permanent damage to the tissue within the compartment.
Treating Chronic (Exertional) Compartment Syndrome
The pain and swelling from chronic compartment syndrome usually resolves with rest and avoidance of the activity causing the pressure. Other non-surgical treatments include:
- Anti-inflammatory medications
- Physical therapy
- Elevation of the affected limb
- Modification of the contributing activity
- Changing exercise surface
- Orthotic inserts in the shoes
- Inclusion of low-impact activities in your exercise routine
- Icing the affected extremity after exercising
For chronic compartment syndrome cases that are unresponsive to non-surgical treatments, surgery may be recommended to relieve the compartment pressure. If you are experiencing symptoms of acute compartment syndrome after suffering a fracture or other injury, seek medical treatment immediately. If you are experiencing chronic compartment syndrome symptoms after exercise, contact the orthopedic specialists at OSMI Ft. Worth for an evaluation. Our Sports Medicine team specializes in prevention, diagnosis, treatment, and rehabilitation of all manners of injuries related to sports and exercise.
Our goal at OSMI is to provide our patients quality, cutting-edge orthopedic treatments, both surgical and non-surgical. If you have questions about orthopedic surgery, joint pain, or physical therapy, please submit an online appointment request or contact our office at 817-529-1900.