What Is Compartment Syndrome? Causes, Symptoms & Treatment
Each group of muscles, blood vessels, and nerves in our arms and legs is contained in a space called a “compartment” and surrounded by a tough membrane called the “fascia”. Fascia is non-elastic in nature; therefore it does not expand or stretch easily. It helps to keep the tissues protected and in place.
What is It?
Compartment syndrome is a painful and potentially serious medical condition that occurs as a result of excessive pressure buildup inside the muscle compartment. Sometimes the pressure inside these compartments reaches a point that it starts to impede the flow of blood to and from the affected area. This compromise in blood circulation may results in temporary to permanent damage to the nerves, muscles, and blood vessels inside the compartment.
Compartment syndrome usually occurs in legs and forearms but other body parts such as arms, feet, abdomen, and buttocks, are also prone to developing this syndrome.
What Are The Different Types?
Depending on the presentation, severity of symptoms, and urgency of treatment, compartment syndrome can be divided into two main types:
This type of compartment syndrome usually happens suddenly, usually after a severe injury such as a fracture, car crash, or sports injury. It is considered a medical emergency since it requires urgent diagnosis and treatment. If not treated quickly, acute compartment syndrome can lead to permanent muscle, nerve, or blood vessel damage.
Chronic compartment syndrome occurs gradually, usually as a result of athletic exertion or following repetitive exercises such as cycling or swimming. It is therefore also referred to as chronic exertion compartment syndrome (CECS). Symptoms usually subside as the offending activity is stopped, but can appear again as the activity is resumed. Since it does not cause permanent damage to the muscles and nerves, it is rarely considered a medical emergency.
Causes of Compartment Syndrome
The main underlying cause of compartment syndrome is excessive bleeding and/or swelling within a compartment. It can also develop as a result of a decrease in the size of the compartment resulting from thermal injuries or using tight bandages or casts. Under both conditions, the blood supply to the muscles and nerves gets affected leading to temporary or permanent damage to the affected muscles, tissues, and nerves.
Acute compartment syndrome can occur as a result of:
- a major injury such as a car accident, fall, or hit
- severe bruising
- anabolic steroid use
- re-established blood flow after blocked circulation
- constricting bandages or plaster casts
- burns, causing the skin to shrink and tighten
Chronic Compartment Syndrome (CECS) can occur as a result of:
- repetitive exercises such as running, swimming, cycling, elliptical training
- intense or frequent workouts
Symptoms of Compartment Syndrome
The following “5 P’s” are often associated with compartment syndrome:
- paralysis (weakness)
- paresthesia (numbness)
- pulseness (faint pulse)
- pallor (pale skin tone)
Other signs and symptoms may include:
The main aim of seeking treatment for compartment syndrome is to relieve pain and to prevent the muscle pressure getting high enough to cause permanent damage to the muscles and nerves.
For patients diagnosed with acute compartment syndrome, especially the ones that result from traumatic incidents, no effective non-surgical treatment methods are available to date. Surgical treatment is the only option for all such patients. The surgery (fasciotomy) which is a minimally invasive procedure involves making long incisions through the skin and the fascia in order to release excessive pressure inside the compartment.
Following fasciotomy, some patients may need a course of manual therapy to help speed up the recovery process and restore a full range of motion.
For patients diagnosed with chronic compartment syndrome (CECS), both surgical, as well as non-surgical treatment options, are available.
The first thing most doctors suggest is to stop performing the activities that trigger the symptoms associated with CECS or switching to less strenuous activities. If there is no relief, the doctor may suggest following conservative treatment methods:
- use of NSAIDs and oral medications such as naproxen and indomethacin
- the use of orthotic devices such as shoe inserts
- physical therapy
- soft tissue massage therapy
Surgery is considered as the last resort if the symptoms persist despite the above measures.