What is Compartment Syndrome?
Compartment syndrome is a serious and painful condition that occurs when pressure within the muscles builds to dangerous levels. This elevated pressure can decrease blood flow, preventing nourishment and oxygen from reaching nerve and muscle cells. Compartment syndrome can be either acute or chronic.
Compartments are groups of muscles, nerves, and blood vessels in the arms and legs. Encompassing these tissues is a tough membrane called the fascia, whose function is to keep the tissues in place. Thus, it doesn’t easily stretch or expand. The area of the leg between the knee and ankle includes four major muscle compartments: the anterior, lateral, superficial posterior, and deep posterior.
Compartment syndrome develops when swelling or bleeding occurs within a compartment. Because the fascia does not stretch, this can increase pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted, which can damage nerve and muscle cells. In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. This does not usually happen in chronic (exertional) compartment syndrome. Compartment syndrome most often occurs in the calf (the anterior compartment of the lower leg). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.
What causes Compartment Syndrome?
Acute Compartment Syndrome. Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. In rare cases, it can appear after a relatively minor injury. Conditions that can cause acute compartment syndrome include:
- A fractured bone.
- A badly bruised leg muscle, caused for example in an accident or a contact sport like football.
- Blood flow restored after blocked circulation, as when a surgeon restores flow through a damaged blood vessel after several hours. A blood vessel can also be blocked during sleep. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. It can happen to people who lose consciousness from severe alcohol or drug intoxication.
- Crush injuries.
- Anabolic steroids. Taking steroids can be a cause of compartment syndrome.
- Constricting bandages. Casts or tight bandages may lead to compartment syndrome. If symptoms occur, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.
Chronic Compartment Syndrome. The pain and swelling of chronic compartment syndrome is caused by repetitive motion exercise, such as running, biking, or swimming. This is usually relieved by discontinuing the exercise, and is usually not dangerous.
What are the symptoms of Compartment Syndrome?
Acute Compartment Syndrome. The primary symptom is severe pain that does not go away when you take pain medicine or raise the affected area. Symptoms of Acute Compartment Syndrome may include:
- Decreased sensation
- Numbness and tingling
- Paleness of skin
- Severe pain that gets worse
Chronic Compartment Syndrome. The main symptom is pain or cramping during exercise - most often in the leg - which subsides when activity stops. Symptoms may also include:
- Difficulty moving the foot
- Visible muscle bulging
How is Compartment Syndrome treated?
Acute Compartment Syndrome. This requires an emergency surgical procedure called a fasciotomy; there is no effective nonsurgical approach. Your doctor will cut open the skin and fascia covering the affected compartment. If swelling is severe, the incision is surgically repaired when swelling subsides, sometimes via skin graft.
Chronic Compartment Syndrome. Nonsurgical treatment can include physical therapy, orthotic inserts for shoes, and anti-inflammatory medicines. Your symptoms may subside if you avoid the activity that caused the condition, perhaps substituting cross-training with low-impact activities. If conservative measures fail, your doctor may recommend a surgical operation designed to open the fascia so that there is more room for the muscles to swell.
Sources: American Academy of Orthopedic Surgeons http://orthoinfo.aaos.org/topic.cfm?topic=A00071
PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025851/