COMPARTMENT SYNDROME

Compartment syndrome is a painful and serious condition caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment. Arms and legs are composed of this group of muscles, and inside those compartments, there are blood vessels and nerves. Surrounding the compartments, we have a thick tissue called fascia.

Compartment syndrome occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. It usually occurs in the legs, feet, arms or hands, but can occur wherever there’s an enclosed compartment inside the body.

Types of compartment syndrome

There are 2 main types of compartment syndrome: acute compartment syndrome and chronic (also called exertional) compartment syndrome.

Acute compartment syndrome:

• Can occur at any age

• Happens suddenly, usually after a fracture or severe injury

• It is a medical emergency and requires urgent treatment

• Can lead to permanent muscle damage if not treated quickly

Chronic compartment syndrome:

• Usually occurs in young people

• Happens gradually, usually during or after repetitive exercise (such as running or cycling)

• Usually pain disappears within minutes of stopping the activity

• It is not a medical emergency and does not cause permanent damage

Symptoms of Acute compartment syndrome

They usually develop after an injury and get worse rapidly. Symptoms can include:

• Intense pain

• Tightness in the muscle

• A tingling or burning sensation

• The affected area turning pale and cold

• In severe cases, numbness or weakness

Symptoms of Chronic compartment syndrome

These tend to develop gradually during exercise and improve with rest. Symptoms can include:

• Cramping pain during exercise, most often in the legs

• Swelling or a visibly bulging muscle

• A tingling sensation

• In severe cases, difficulty moving the affected body part

Medical advice

You must seek immediate advice and go to the nearest Emergency department as soon as possible if you think you have an acute compartment syndrome.

Speak to your GP or physiotherapist for advice if you think you have chronic compartment syndrome. Chronic compartment syndrome is much less serious.

Acute compartment syndrome can be caused by:

• A broken bone

• A plaster cast or tight bandage

• Skin burns

• In rare cases, it can occur without any obvious injury

Chronic compartment syndrome is caused by muscle swelling during exercise. This can be due to:

• Larger amounts of blood being pumped into the compartment

• Difficulty of the blood to exit the compartment

• Tightening of fascia diminishing its capacity to hold large amounts of blood in the muscle bundle while exercising

Diagnosis

Both types are diagnosed clinically with a thorough medical history and examination. However, in some circumstances, the diagnosis can be achieved by measuring the pressure inside the muscle compartment with special needles.

Treatments for compartment syndrome

Acute compartment syndrome must be treated in hospital using a surgical procedure called fasciotomy. This opens the skin and fascia immediately relieving the pressure inside the compartment. The wound will usually be closed a few days later. Rarely, a skin graft is required to cover the wound.

Chronic compartment syndrome is relieved by stopping the exercise that triggers it and switching to a less strenuous activity. Surgery will only be considered if symptoms persist after these modifications. A fasciotomy as an elective patient will be performed.