Compartment syndrome gets its name because it affects a specific muscle compartment. Muscle compartments are groups of nerves, blood vessels, and muscle tissue in your arms and legs encased by a tough membrane called fascia. Compartment syndrome occurs when there is increased pressure in a muscle compartment. This is often caused by muscles swelling and pressing against the fascia, as fascia do not expand. This can result in damage to the tissues and nerves inside the compartment. If the pressure increases significantly, blood flow is cut off to the compartment. This causes oxygen loss in the tissues and cellular death.
Compartment syndrome types
There are two distinct types of compartment syndrome: acute and chronic. Acute compartment syndrome is much more severe and classified as an emergency. If proper treatment is not received, this can result in permanent muscle damage. Generally speaking, chronic compartment syndrome is not classified as an emergency.
What causes compartment syndrome?
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Acute compartment syndrome is usually the result of a major trauma to the area but can sometimes occur after minor injuries. Some causes of acute compartment syndrome include crush injuries, burns, overly tight bandaging, prolonged compression of a limb while unconscious, surgery to blood vessels in an arm or leg, a blood clot in an arm or leg, and extremely vigorous exercise. Approximately 75 percent of the time, acute compartment syndrome is caused by a bone fracture.
Chronic compartment syndrome is most frequently caused by extreme exertion, especially by athletes. The most common activities that cause chronic compartment syndrome include running, swimming, cycling, and training with an elliptical machine. The majority of patients are under age 40, but it can develop at any age with enough strain to the compartment. Taking steroids can increase the risk of developing chronic compartment syndrome.
Complications of compartment syndrome
Complications of compartment syndrome, when it is acute, can include severe muscle damage and even amputation. Permanent damage can be sustained within a few hours if treatment is not administered. Damage includes tissue scarring, loss of limb function, infection, nerve damage, and muscle breakdown leading to kidney damage.
When chronic, complications are rarer, but can also include the types of damage as acute. If you are in pain or have noticeable swelling, do not exercise the area and consult your doctor.
What are the symptoms of compartment syndrome?
The symptoms of acute compartment syndrome can be remembered by looking at the five Ps: Pain, Passive stretch, Paresthesia, Pallor, and Pulse. Pain is the most common symptom associated with compartment syndrome, whether it’s acute or chronic. As the muscle is lacking in blood, it will be highly sensitive to stretching. Paresthesia is the pins and needles or prickling sensation some patients feel leading up to numbness in a body part. Due to the lack of blood, the limb may appear pale or dusky in color. The compartment may also present a weakened or completely stifled pulse.
Chronic compartment syndrome is characterized by pain, cramping, and swelling during exercise. These symptoms often fade once the activity has been stopped. Other symptoms can include numbness, visible muscle bulging, or trouble moving the foot if it occurs in one leg.
How to diagnose and treat compartment syndrome
It is possible for a compartment syndrome diagnosis to be established simply from a physical exam and the patient’s description of their symptoms. More often, a diagnosis requires measurement of the pressure inside the muscle compartment directly. For this, a doctor will insert a needle with a pressure monitor attached to it into the compartment. In order to diagnose compartment syndrome in the abdomen, insertion of a pressure monitor into the bladder through a catheter is required.
If the compartment syndrome is caused by an injury, treatment of the injury is the most crucial step in the treatment of the syndrome. For acute compartment syndrome, surgery is the only treatment option. The surgeon will cut through the fascia to release the pressure built within. In severe cases, it can take several hours for enough pressure to be released before the compartment can be resealed.
Chronic compartment syndrome does not usually need treatment and will resolve on its own. If it does not, a doctor may recommend physical therapy, anti-inflammatories, elevating, resting, and icing the limb.
Exercises for compartment syndrome
Exercise should be limited when suffering from compartment syndrome. If a particular activity is a cause of chronic compartment syndrome, it should be avoided. Ideally, patients would rest until symptoms are completely eradicated, but this can mean taking long breaks from physical activity, which is not feasible for all professional athletes. A foam roller can be used to roll out the muscles after exercising, which can lessen the symptoms.
Prevention and prognosis of compartment syndrome
If compartment syndrome is properly diagnosed and treatment is administered in a timely fashion, the prognosis for recovery is very optimistic. The muscles and nerves inside the compartment should recover fully depending on the injury that caused the syndrome. If the diagnosis is delayed, permanent damage can set into muscles and nerves in as few as 12 hours.
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It is not fully possible to prevent this condition. If an injury is sustained, it is highly likely that compartment syndrome will also occur. If exercise is monitored and proper stretching and muscle rolling is used post-exercise, chronic compartment syndrome can be managed. Prompt diagnosis and treatment are the best chance for a patient to make a full recovery.
Compartment syndrome is caused by excess pressure inside a muscle compartment, trapped in by the rigid fascia membrane. It can either be acute, which require immediate medical attention, or chronic, which will often resolve itself. Acute compartment syndrome symptoms are characterized by the five Ps: Pain, Passive stretch, Paresthesia, Pallor, and Pulse. Symptoms of compartment syndrome, when it’s chronic, often include pain and visual swelling of the area. Causes vary from over-exercising to major injuries. Diagnosis and treatment of acute compartment syndrome are generally invasive and result in surgery. If treated quickly, compartment syndrome should not result in permanent damage. If left untreated, it can lead to permanent muscle, nerve damage, and even amputation.
Related: 16 muscular system diseases you should know about
