Compartment syndrome is a very painful and dangerous condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease the blood flow to the leg, which prevents oxygen and nutrients from reaching the muscle cells.
There are 2 types of Compartment syndrome, called Acute or Chronic.
Acute compartment syndrome is a medical emergency. It is usually caused when your tibia is fractured (broken) or when it has sustained a severe crush injury. If it isn’t diagnosed and treated quickly, it can lead to permanent damage to your leg.
Chronic compartment syndrome is very much different. It is most often caused by exercising and is not a medical emergency.
Symptoms
The hallmark of compartment syndrome is intense pain that seems to be out of proportion to the injury. Other symptoms you may experience are:
- Paraesthaesia: Tingling or burning sensations in the skin.
- Pallor: Your leg will look pale and feel cold to the touch.
- Your muscle may feel full or tight.
- Paralysis: Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.
Causes
Acute
This usually happens after major trauma like a car accident or anything that has the ability to break your bones. Some more specific causes of acute compartment syndrome are:
- A fracture: Usually of the tibia (lower leg) or the bones of the forearm
- A badly bruised muscle or crush injury: When a motobike falls on the leg of a rider or a limb is crushed under an object
- Ischaemic-reperfusion: After a blood vessel is blocked (eg.After lying for a long time) ischaemia happens (low blood flow). When it is unblocked (from getting up or moving around) reperfusion happens as the vessel unblocks and in this state a compartment syndrome can occur. It is similar to unkinking a twisted hose, with the water now being able to flow through again. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.
- Overly tight bandages: Plaster casts and bandages that has been applied too tightly can lead to compartment syndrome. If this occurs try to loosen the bandages/cast and if unable to call your doctor immediately.
- After surgery: You can sometimes get compartment syndrome in that compartment where you were operated on
Chronic
Compartment syndrome can happen due to exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.
Risk Factors
The main risk factor for acute compartment syndrome is injury. For chronic compartment syndrome the main risk is repetitive exercise.
Investigations
The diagnosis is usually made just by the doctor examining you. However, the definitive diagnosis of compartment syndrome is confirmed by measuring the pressure within the compartments of the affected limb. A sterile needle is inserted directly into the muscle compartment and attached to a pressure monitoring device. The doctor may also order an x-ray to see if you have any underlying fracture of the bones in the affected area.
Complications
If compartment syndrome is missed or untreated the complications can be irreversible. As the compartment swells and the muscles loses its blood supply cells eventually die causing muscle death.
Some complications are:
- Muscle scarring or contracture, and loss of the limb function
- Infection
- Amputation
- Permanent nerve damage
- Rhabdomyolysis and kidney damage
Treatment
Acute Compartment Syndrome
This is a surgical emergency and the only effective treatment is surgery. Your doctor will make an incision and cut open the skin and fascia covering the affected compartment (fasciotomy). Sometimes the wound cannot be closed immediately and occasionally to repair the wound a skin graft may be used.
Chronic Compartment Syndrome
Non-surgical: Sometimes just avoiding the activities which cause your condition is all that is needed. Cross-training with low-impact activities may be an option. Sometimes just changing the surface you do your exercise on can help. Inserts for your shoes, physical therapies and anti-inflammatories may be recommended.
Surgical: In usual cases of chronic compartment syndrome, the operation isn’t urgent and is instead elective. As described earlier, a fasciotomy can be done.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
It is likely there is no way to prevent this condition, however, early diagnosis and treatment will help prevent many of the complications.
If you have a cast you have an increased risk of swelling and you should see your doctor or go to the emergency room if pain under the cast increases despite trying pain medication.
F.A.Q. | Frequently Asked Questions
What can I do in an emergency setting?
You can remove all constricting clothing around the area and make the patient raise their leg. Immediately get the patient to a hospital.When can I expect full recovery?
It depends on if you have muscle death, and if so, how much. Usually full recovery takes 1-2 months.
Can surgery be avoided?
If this is acute compartment syndrome then surgery is the ONLY cure.