Compartment Syndrome

Compartment syndrome occurs when an injury causes painful swelling and increased pressure within a compartment, preventing blood supply to muscles and nerves.

Muscles in the forearm, lower leg, and other areas are surrounded by fibrous bands of tissue, creating compartments. These compartments cannot stretch to accommodate swelling, leading to muscle and nerve failure.

Although most common in the forearm and lower leg, compartment syndrome can also occur in other parts of the body with muscle compartments, such as the hands and feet.

Compartment syndrome can occur acutely from injury-related swelling or chronically from exertion.

Causes of Compartment Syndrome

Compartment syndrome is caused by increased pressure within compartments due to swelling or bleeding from injury. Pressure greater than normal leads to inadequate blood circulation, resulting in pain and swelling.

Loss of blood and oxygen supply causes muscle cell death. If untreated, this can result in complete muscle death, scarring, and contraction. Damaged nerve cells can cause numbness and weakness beyond the injury site. In severe cases, amputation may be necessary.

Risk Factors for Compartment Syndrome

Acute compartment syndrome can occur as a complication of fractures, significant bleeding, or crush injuries in the forearm or lower leg. It can also result from extended immobility or compression of muscles.

Compartment syndrome can develop after reperfusion swelling, burns, snake bites, envenomation, or anabolic steroid use. Anticoagulant users also have a higher risk for bleeding-related compartment syndrome.

Chronic compartment syndrome is caused by excessive exercise and often affects the legs in runners and bicyclists or the arms in swimmers. Symptoms improve with rest and rarely become a limb-threatening situation.

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Symptoms of Compartment Syndrome

Symptoms of compartment syndrome, such as disproportionate pain and change in sensation, confirm the diagnosis. The "5 Ps" (pain, paresthesia, pallor, paralysis, and poikilothermia) can be indicators, but pain and change in sensation are the most significant.

Compartment syndrome should be considered when there is an associated fracture, high-velocity injury, or immobilization. Swollen, shiny, and bruised skin with limited range of motion may be observed.

Chronic compartment syndrome causes pain during exercise, muscle bulging, and numbness that resolve after discontinuing activity.

When to Seek Medical Care for Compartment Syndrome

Acute compartment syndrome is an emergency. If the compartment pressure is not released within a few hours, permanent muscle and nerve damage may occur.

Medical care should be sought for symptoms such as numbness, tingling, weakness, or excessive pain after an injury. Compartment syndrome can occur in various body parts after a fracture or crush injury.

Diagnosis of Compartment Syndrome

Suspected acute compartment syndrome requires a high level of suspicion. A patient’s history and symptoms are crucial for diagnosis.

Blood tests may be done to assess muscle injury and kidney damage markers. The definitive diagnosis is made by measuring compartment pressure directly in the affected limb. Chronic compartment syndrome may be diagnosed clinically or confirmed through pressure measurements before and after exercise.

Treatment for Compartment Syndrome

Prevention is crucial in the treatment of compartment syndrome. Injuries requiring casting or splinting should be elevated and iced to reduce swelling.

Chronic compartment syndrome usually does not require treatment, but if symptoms become limiting, surgery may be an option to relieve symptoms by cutting some of the surrounding fasciae.

Surgery (Fasciotomy) for Compartment Syndrome

Surgery is the primary treatment for acute compartment syndrome. Fasciotomy, where fibrous bands surrounding muscles are opened, allows for muscle swelling and pressure relief. Hyperbaric oxygen therapy may be used after surgery for healing promotion.

Underlying causes of compartment syndrome are also addressed, and complications, including kidney damage, are prevented.

Prognosis and Complications of Compartment Syndrome

Acute compartment syndrome requires prompt surgery to prevent permanent muscle and nerve damage. Timely intervention increases the chances of restoring normal function.

The prognosis for chronic compartment syndrome is generally excellent.

Complications of untreated compartment syndrome include muscle scarring, loss of limb function, infection, amputation, permanent nerve damage, muscle breakdown, and kidney damage.

Complications related to chronic or exercise-induced compartment syndrome are rare, but surgery may be necessary in severe cases.