Overview

What is compartment syndrome?

Compartment syndrome is a severe condition that occurs when a muscle compartment has high pressure.

These are segments of muscle tissue, blood vessels, and nerves in your arms and legs covered by a very tough membrane called fascia. Because the fascia does not stretch, swelling of a compartment can cause pressure within the compartment to increase. The trauma occurs to the muscles, blood vessels, and nerves contained within the compartment.

The pressure increase can lead to the compromise of the blood flow to the compartment. This will cause a lack of oxygen in the tissues (ischemia), hence cellular death (necrosis).

What are the types of compartment syndrome?

There are two types of compartment syndrome:

Acute compartment syndrome: Acute compartment syndrome develops suddenly (often after a significant injury). It is a medical emergency. Seek prompt medical attention in the emergency room if you suspect that you have developed acute compartment syndrome. Untreated acute compartment syndrome can result in permanent muscle damage and paralysis or even death.
Chronic compartment syndrome: Chronic or long-standing compartment syndrome generally presents over time, often after significant levels of physical activity or exercise. It is seldom an emergency but can be very painful. Some providers have termed it exertional compartment syndrome.

What are the symptoms of compartment syndrome?

The most common signs and symptoms of compartment syndrome involve:

Visible swelling or bulge over a muscle
Muscle pain (more severe than soreness you would experience after extremely strenuous activity)
Tightness
Severe pain when stretching
Numbness
Tingling or burning underneath your skin (paresthesia)
Feeling like your muscle is fuller, firmer or larger than it normally is.

What causes compartment syndrome?

Acute compartment syndrome generally develops within a few hours after a severe injury to an arm or leg. Among the common symptoms of acute compartment syndrome include:

A current, ongoing, severe pain in one arm or leg.
Pain that appears to be more severe than one would anticipate, given the extent of the damage
A limb's numbness, pins and needles, or pain that seems electric
Bruising, constriction, and swelling
Absence of feeling
Pain that persists beyond treatment with measures such as pain medicine or icing and elevating the limb
Pale skin in the affected area

Symptoms of chronic exertional compartment syndrome include aching or cramping in the affected muscle (buttock, thigh, or lower leg) that worsens within 30 minutes after initiating exercise. Leg symptoms can produce foot drop (difficulty lifting the front of the foot when you walk, which sometimes makes you drag your foot). The symptoms usually resolve with rest, and the muscles function normally. It can feel like shin splints and be mistaken for that syndrome because it does not necessarily follow exertion.

Abdominal compartment syndrome commonly occurs in hospitalized, critically ill patients who are receiving life support. They can often describe their symptoms: doctors or family may note the following clinical signs:

A tense, distended abdomen
Wincing if the abdomen is pressed
Urine output slowing or stopping
Low blood pressure

What are the risk factors?

Any person, in fact, can have the risk of developing acute compartment syndrome because it presents after sudden injuries.

Athletes and people whose jobs require physical exertion tend to overtrain or overwork their muscles and are more likely to develop chronic compartment syndrome.

People suffering from hemophilia and many other blood disorders are more likely at risk.

What are the compartment syndrome complications?

Compartment syndrome complications can be very severe.

If the pressure within your muscle compartment becomes too high, then your tissues are not getting an adequate supply of fresh blood, oxygen and nutrients. This causes tissue death (necrosis) and permanent damage.

Acute compartment syndrome can be fatal if not treated promptly. If you believe that you have acute compartment syndrome, go to the emergency room immediately.

How does a doctor diagnose compartment syndrome?

A physical examination and other tests will be used by a physician to diagnose compartment syndrome. They'll check your muscles and the surrounding tissue. Initially, they may rule out other conditions that might produce comparable symptoms, such as tendinitis or shin splints.

Inform your doctor of your actions when the pain and other symptoms began. Let your doctor know which activities provoke the worsening or improvement of your symptoms.

Tests to determine compartment syndrome

Your doctor may perform a few tests in making a compartment syndrome diagnosis, including:

X-ray: This will be done to help exclude other kinds of fractures and injuries.
Compartment pressure measurement test: The healthcare provider will insert a needle in several places inside the muscle compartment. A machine attached to the needle will measure the pressure inside your body. This test may be painful. Let your healthcare provider know how much it hurts when they insert the needle and where it hurts the most.
Repeat pressure test: If your practitioner suspects that you have chronic compartment syndrome, they may repeat a compartment pressure test after you exercise. They can then compare the before-and-after pressure levels.

What are the treatments for compartment syndrome?

All this depends on the type of compartment syndrome you have.

Acute compartment syndrome is an emergent condition, meaning you'll need surgery as soon as possible. Chronic compartment syndrome usually improves once your exercise habits or routine are modified.

Acute compartment syndrome treatment

A surgeon will operate to make an incision or cut in your skin and fascia to relieve pressure in the muscle compartment you have affected.

They will close the cut once all the swelling and pressure have gone away. Unfortunately, that's not always possible right away. Your surgeon may perform a skin graft, transferring your body's own skin to the site over the incision.

Chronic Compartment Syndrome Treatment

Chronic (exertional) compartment syndrome often improves and even disappears with plenty of rest as a result of avoiding activities that strain the involved muscle compartments. Your doctor will recommend treatments to help control symptoms and avoid pressure increases. These include:

Medications: Anti-inflammatory medications such as over-the-counter NSAIDs or acetaminophen reduce inflammation and ease pain. Do not take these medications for more than 10 consecutive days without consulting your doctor.
Changing your exercise routine: You may need to do other, less stressful exercises. Some individuals with compartment syndrome cross-train. Cross-training is what happens when you mix up which type of exercise you are doing instead of doing the same kind or with the same activity every time. You also might have to change where you work out-from running on a softer track rather than concrete.
Physical therapy: A physical therapist can help you build strength and flexibility within your affected muscles. They can also provide ways of modifying your exercises to not cause stress and pressure buildup.
Orthotics: Orthotics is shoe inserts meant to support your feet and legs. These may help with the management of patients with leg compartment syndrome. Your provider will indicate which of these orthotics work best for you.

You may need a fasciotomy if other treatments are not working or if you have a recurrence of the compartment syndrome. Let your provider know if it is time to consider surgery and what to expect.

How can you prevent compartment syndrome?

You cannot prevent acute compartment syndrome since it appears suddenly following a trauma, or as an unexpected complication. If you feel or suspect you have acute compartment syndrome, the best way to avoid serious complications is by seeking immediate attention in the emergency room.

If you have an immobilizing device such as a cast or splint, and it feels too tight, especially if you've taken pain medicine and that part of your body still hurts or swells, tell your provider. Your provider can tighten your immobilizing device to prevent compartment syndrome.

Chronic compartment syndrome is best prevented by not putting too much stress on your muscles. Follow these tips to reduce your risk:

Avoid overtraining — Don't "play through pain" if your muscles ache during or after exercise.
Warm up and stretch before you start exercising. Cool down and stretch after highly intense exercise.
Gradually increase your endurance: Avoid increasing the intensity of your workouts all at once.
Variety in workouts: Avoid doing the same workout, in the same manner each time you exercise.
If feasible, avoid doing your exercise on a hard, stiff surface or concrete and tile floors.

What can I expect if I have compartment syndrome?

Severe pain is the hallmark of the condition, but your symptoms should actually improve when you start managing them.

Acute compartment syndrome rarely recurs in patients after a fasciotomy. However, speedy diagnosis and treatment of the condition are vital. The longer you have untreated acute compartment syndrome, the higher your risk of permanent damage.

Chronic compartment syndrome may recur, particularly if you suddenly increase your activity level. Ask your provider which activities can be done safely while you are recovering.

You may not be able to resume intense physical activity until up to a year after surgery.