Compartment syndrome is a painful and potentially damaging condition that generally affects athletes or someone that has over-exerted themselves physically. Compartment syndrome should be checked out by your doctor or orthopedist as soon as you suspect any symptoms as it can cause lasting and widespread damage to any affected extremities.
Muscles are made up of different groups of muscle fibers, called compartments, that are each protected by layers of fascia, which is a connective tissue. Muscle fibers are elastic, the fascia coating is not. Compartment syndrome occurs when swelling occurs in one or more of the muscle compartments. This swelling can be caused by trauma from an injury or athletic strain. The fascia cannot expand to handle the swelling, and pressure on the muscle, blood vessels and nerves increases to damaging levels. Lack of blood flow caused by the swelling can lead to tissue death.
There are two types of compartment syndrome: chronic and acute. Chronic compartment syndrome is usually caused by athletic over-use of the particular muscle, and is generally less severe. It still requires treatment, but is less likely to cause permanent tissue damage.
Acute compartment syndrome, on the other hand, is a medical emergency that if left untreated, can result in loss of the limb with the affected muscles or permanent tissue damage. Acute compartment syndrome generally results from a traumatic injury, and the resulting swelling in the muscle compartment can occur rapidly. External compression from a cast or bandage can also cause acute compartment syndrome.
You can usually tell if you have compartment syndrome if you have severe pain that doesn’t go away with a typical round of pain killers, and you have either exercised vigorously recently or had some sort of accident. Other symptoms of compartment syndrome include tingling or numbness from the swelling pressing on the nerves, paleness from the swelling cutting off blood supply to the muscle, or weakness from the swelling affecting muscle function. The pain usually comes from deep in the muscle or extremity and it is often difficult to locate the “origin point” of the pain. The muscle may also have a full feeling and be stiff and difficult to move.
To confirm compartment syndrome, the doctor must measure the actual pressure inside the muscle compartment to verify that it is above normal. A needle with a pressure sensor is inserted into the muscle compartment and a diagnosis of compartment syndrome usually requires a pressure higher than 30 mm Hg. The test must occur when the pain occurs in order to get a proper pressure reading.
Acute compartment syndrome always requires surgery, and should be treated immediately. Nerve and tissue damage can occur after 12 to 24 hours without treatment, so prompt attention is critical. The surgery involves cutting open the fascia surrounding the affected muscle compartment(s) to give the swelling room to expand and heal. This will reduce the pressure on the muscle and prevent damage. In cases of extreme swelling, skin grafts might be needed to close the surgical wound.
Chronic compartment syndrome is usually initially treated with some physical therapy as well as avoiding the activity that caused it. If that does not relieve the swelling, doctors can also use the same type of surgery as for acute compartment syndrome, only it is not an emergency surgery for chronic compartment syndrome.
There is no effective way to prevent compartment syndrome, so it is important to know the symptoms and warning signs and to seek immediate treatment if any type of compartment syndrome is suspected.
Mark A. Jenkins, M.D., “The Compartment Syndrome” Sports Med Web.
Richard Paula, M.D., “Compartment Syndrome, Extremity” e-medicine from WebMD.
“Compartment Syndrome” Medline Plus.
“Compartment Syndrome” American Academy of Orthopedic Surgeons.