Introduction
Compartment syndrome is a serious medical condition that requires swift diagnosis and treatment. It can affect any part of the body, but usually occurs in the arms or legs. It occurs when swelling or increased pressure inside a compartment causes blood flow to be disrupted, which can lead to severe pain, numbness, and long-term tissue damage if left untreated.
The goal of treatment for compartment syndrome is to reduce the pressure inside the affected compartment and restore normal circulation. Treatment usually includes:
- Rest
- Immobilization of the affected limb with a splint or cast
- Elevation of the affected limb above heart level
- Pain relief medications such as ibuprofen or acetaminophen and/or anti-inflammatory drugs
- Intravenous fluids to control swelling inside the compartment
- Use of a tourniquet to reduce swelling temporarily until medical care is available (Rarely used)
- Needle decompression of tight muscles and fascia (frequently used)
- Fasciotomy surgery where necessary (rarely used)
It is important for individuals who experience these symptoms to seek immediate medical attention in order to prevent long-term damage from occurring.
Causes
Compartment Syndrome is a painful and serious condition caused by increased pressure in a muscle area that can lead to nerve and tissue damage. It can be caused by any activity that causes the muscle to be overused, as well as trauma, illness, or injury.
Understanding some of the causes can help prevent and treat the condition:
Trauma
Compartment syndrome is an injury that occurs when muscle tissue within a certain part of the body experiences a lot of pressure. Compartment syndrome is often caused by a direct or indirect trauma to the area, such as a fracture, sprain, mid-long (bruise), burn or other penetrating trauma. Other less common causes include reperfusion injury caused by artery occlusion or thrombosis, intramuscular injection and overuse syndromes such as chronic exertional compartment syndrome.
In some cases, compartment syndrome can be caused by wearing restrictive clothing or tight bands on the limb. This is particularly common in athletes competing in endurance sports who wear restrictive legwear to improve their performance.
Excessive exercise
Excessive exercise can be a major cause of compartment syndrome. Certain activities such as running and weight training can cause a buildup of pressure within the muscle compartments. When this occurs, the blood vessels, muscles, nerves and other tissues in the affected area become compressed. This compression leads to impaired circulation, decreased nerve conduction and ischemia (reduced oxygen supply).
Other causes may include:
- Traumatic injuries such as vehicle accidents or blunt force trauma.
- Fractures.
- Significantly tight dressings on the extremity.
- In severe cases, excessive tissue swelling from burns or extreme cold can also cause this condition as well.
In many cases of compartment syndrome from excessive exercise, there is no single identifiable event that triggers it in athletes who lack a significant traumatic injury history. Poor training techniques may uncomfortable postures such as flexing certain muscle groups for too long without taking appropriate rest breaks between sets, which can lead to over-exertion and an eventual increase in tissue pressure that causes compartment syndrome. Painful activities involving repetitive motions may also be contributing factors when done in an improper or excessive manner.
Vascular disease
Vascular diseases can cause compartment syndrome in more than one way. Vascular insufficiency, a decrease in blood supply to the limbs, can cause difficulty in the healing of traumatic injuries that could lead to compartment syndrome. Vascular diseases such as arterial calcification and paralysis of the nerves involved with muscle movement can also result in an increase of compartmental pressure.
If a person is predisposed to developing vascular diseases, identifiable risk factors include physical activity, diabetes and hypertension (high blood pressure). Treatments for compartment syndrome caused by vascular disease depend on individual cases and could include vasodilators or surgery to remove required tissue, among other treatments.
Symptoms
Compartment syndrome is a serious medical condition where the tissue pressure inside a compartment of the body is elevated to a point where it can affect blood flow to the limb and cause other issues.
Signs and symptoms may include:
- Pain with activity
- Swelling
- Extreme tightness in the affected area
- Numbness
- Tingling
- Weakness in the limb
It is important to be aware of these symptoms, as early diagnosis and treatment are key in avoiding damage to nerves and muscles.
Pain
Compartment syndrome is an uncommon but potentially serious condition, caused when there is increased pressure within one of the body’s compartments. The increase in pressure can damage tissues and nerve cells if it is not relieved quickly. Compartment syndrome can be brought on by exercise, injury or surgery.
Signs and symptoms of compartment syndrome include:
- Pain: Pain is typically the first symptom that people experience with compartment syndrome. The affected limb may repeatedly feel very tight, as if in a vice-like grip. It may initially come and go but then can become persistent over time. The pain may be mild to severe but increases in intensity when attempting to move the limb, especially after exercise or applying direct pressure (elevation and stretching).
Swelling
One of the main symptoms of compartment syndrome is an increase in pressure within a muscle group, which can lead to swelling. This swelling can be felt as a firm yet tender mass while attempting to move the affected limb, which will then subside after exercise has concluded. However, if too much pressure is built up within the muscle, it can become very painful and inflamed even at rest. In severe cases, it is possible for permanent damage or tissue death to occur without proper treatment.
In order to prevent such cases from occurring, it is important for those experiencing any degree of swelling in their limbs or associated with physical activity to see their doctor as soon as possible:
- Firm yet tender mass when attempting to move the affected limb.
- Pain and inflammation even at rest.
- Permanent damage or tissue death without proper treatment.
Numbness
The most common symptom of compartment syndrome is a feeling of numbness in the affected limb. Other common symptoms can include sensations such as tingling, burning pain and weakness. If left untreated, physical effects can include increased pressure in the injured area and decreased blood supply to that limb. This can cause further damage to nerves, muscles, and other structures as well as limited motion of the affected body part.
It is important to seek medical attention immediately if these symptoms are experienced in order to minimize long-term damage from compartment syndrome.
Weakness
Weakness may be the first symptom of compartment syndrome. The affected limb may not have full strength, and it’s not uncommon to experience a feeling of tightness or aching. In some cases, pain is minimal, even when the muscle is squeezed and palpable pressure is detected in the affected area. Other people experience a burning or stinging type of pain that worsens with any kind of movement.
As the condition progresses, it’s likely to affect your ability to move that limb. You may also feel numbness or tingling if the condition has been present for some time.
Diagnosis
The diagnosis of compartment syndrome involves assessing the patient’s medical history, physical exam, and other diagnostic tests. Tenderness, swelling, and increased pressure in the affected area are signs that there may be compartment syndrome. Imaging tests such as x-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may also be used to diagnose compartment syndrome.
Physical exam
Compartment syndrome is difficult to diagnose, and often relies on the physical examination. It is important to note the warning signs and to identify which of these signs are present. During the physical exam, several areas where compartment syndrome frequently occurs should be checked including legs, feet, arms and hands.
The physical exam should include checking the area for pain with movement or pressure which increases during elevation of the affected limb. Tenderness on palpation may also be present in the affected area, often near a particular muscle or joint articulation. A swelling or tightness may also appear in the affected extremity if swelling is present, preventing passive joint movement or causing limitation of range of movement as well as any other noticeable changes such as discoloration or an uneven temperature compared to opposite limb segments.
In addition to performing a physical examination your doctor may order an MRI (Magnetic Resonance Imaging ) scan to help diagnose compartment syndrome more accurately. This type of imaging uses magnetic fields and radio waves in order to create detailed images of the body’s soft tissue structures such as muscles, ligaments, tendons and nerves that would not be visible through other imaging tests such as x-ray or CT scan. An MRI allows your doctor to view any surrounding swelling and determine if it is causing an increased pressure inside one of your body’s compartments that can lead to compartment syndrome.
Imaging tests
Imaging tests are used to diagnose compartment syndrome. Common tests include X-rays, ultrasounds, and MRI scans.
- X-rays are usually not very effective at detecting compartment syndrome, however they are helpful in ruling out other causes of the symptoms like fracture or arthritis.
- Ultrasounds can help diagnose acute compartment syndrome by demonstrating extravasation or bleeding into a muscle belly, as well as identifying fluid collections around the muscles.
- MRI scans may reveal signs of soft-tissue edema and swelling of the muscles in an affected compartment, as well as any subsequent degenerative changes. It is often necessary to perform serial MRI scans to monitor changes in tissue and pressure due to the dynamic nature of compartment syndrome.
Blood tests
Blood tests may be used to diagnose compartment syndrome, as well as to confirm or rule out other medical conditions that can be confused with it. Tests such as a white cell count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) help the doctor to determine whether an infection is present in the body.
A complete blood count (CBC) measures red and white blood cells, platelets, hemoglobin and hematocrit levels. These results can help diagnose any underlying conditions that may be causing the compartment syndrome.
Additionally, other lab tests such as liver function tests and urinalysis may be conducted to look for factors that could indicate increased risk for developing compartment syndrome.
Treatment
Compartment syndrome is a condition in which the pressure within the muscles increases to a dangerous level causing pain and disruption to blood flow. Treatment for compartment syndrome can vary depending on the cause and severity of the condition.
In most cases, surgical decompression is the only effective treatment to release the pressure in the compartment and restore the normal flow of blood. Other non-surgical treatments may also be considered depending on the underlying cause of the compartment syndrome.
Rest
Rest is the cornerstone of treatment for compartment syndrome. This means avoiding activities such as running, jumping or lifting that would increase swelling and pressure in the affected muscle tissues. It is important to remember that rest alone may be insufficient to treat this condition and medial attention should be sought if symptoms persist or worsen.
Medication may also be prescribed to reduce inflammation and manage pain. In some cases, a period of wear and tear on footwear or the application of supportive bandages to the affected area may offer relief. In severe cases, a surgical procedure known as a fasciotomy (cutting of fascia tissue) may be necessary to release the pressure from within the compartment.
Ice
Ice is a recommended form of treatment for compartment syndrome, especially for mild cases. Applying ice to the affected area can reduce swelling and help relieve some discomfort by inhibiting inflammation.
For best results, wrap ice in a towel and apply to the affected area for up to 15 minutes, repeating every two to three hours. It is important not to apply an ice pack directly to the skin as it can cause frostbite. It is also important to be mindful of controlling the temperature of the ice pack and remove it if it becomes too cold or uncomfortable.
Compression
Compression is the most commonly used treatment for compartment syndrome, and it’s an important step in relieving the pressure and pain. Compression may be applied using an elastic bandage or wrap, placed around the limb. Compressing the muscle can help reduce swelling and restore normal blood flow to the affected area. If a cast is used, it should not be too tight. Numbness and tingling should cease after the compression stops.
Physical therapy may also be recommended to help reduce swelling and strengthen muscles. Stretches and range-of-motion exercises will help improve circulation while also strengthening muscles to prevent further episodes of compartment syndrome. The physical therapist will also closely monitor recovery progress by measuring muscle circumference at regular intervals in order to detect any abnormalities that may require medical attention quickly:
- Stretches and range-of-motion exercises to improve circulation and strengthen muscles.
- Measurement of muscle circumference at regular intervals to detect any abnormalities.
Elevation
Elevation is a common treatment for compartment syndrome. This involves elevating the affected limb or area to an elevated level, typically higher than the heart. The purpose of this exercise is to help relieve pressure on the muscles and tendons of the affected area.
This can be done by lying on your side and raising the injured leg or arm at a 45 degree angle using pillows or towels to support it. Elevating the injury can also help reduce swelling, circulation and discomfort.
For best results, seek medical intervention as soon as possible and repeat elevation several times throughout the day as needed for up to 48 hours after injury.
Surgery
Surgery is the primary treatment for compartment syndrome. This procedure, known as a fasciotomy, is done to relieve the pressure in the affected muscle group by cutting away some of the constricting fascia and making a larger living space for the compartments.
A surgeon will make an incision into each of the tight compartments and find whether there’s a difference in pressure between the outside of each compartment and the inside. The surgeon then cuts away some of the fascia until any differences in pressure are equalized. Then, once equalized, attention must be given to protecting any nerves or arteries that lie within these compartments from injury during this procedure.
The surgery must be done soon after diagnosis to prevent nerve and muscle damage from occurring due to lack of blood circulation in those areas due to increased pressure from swelling. After surgery, physical therapy may help with recovery time because there may be some residual weakness after surgery, depending on how long it took for diagnosis and treatment to occur relative to symptoms.
Prevention
Compartment syndrome is a medical condition that can result in serious complications and requires urgent medical attention.
The best way to prevent compartment syndrome is to take steps to lower your risk of developing it. This includes being aware of the signs and symptoms, avoiding activities that put too much pressure on the body, and being mindful of any injuries you may have or any conditions that might increase your risk.
Additionally,
- wearing well-fitted footwear
- properly protecting your limbs during strenuous activities
may help lower your risk of developing compartment syndrome.
Wear protective gear
Wearing protective gear can help prevent compartment syndrome. Protective gear should be worn when participating in activities that involve repetitive or heavy exertion or direct trauma. This includes playing sports or activities, such as skiing, where there is a greater risk of overuse or injury to your limbs.
For athletes, wearing the appropriate protective equipment is especially important because impact injuries to muscles and tendons can lead to compartment syndrome. Protective gear such as shin guards, shoulder pads, elbow protection and knee guards can all help reduce the risk of sustaining a traumatic injury as well as associated complications like compartment syndrome.
Additionally, wearing lighter weight clothing that does not constrict your limbs and ensures proper airflow is beneficial in preventing heat build-up within muscle compartments which can cause swelling and increase pressure within the area, thereby leading to compartment syndrome.
Avoid strenuous activities
In order to prevent the onset of compartment syndrome and limit the severity of any symptoms, avoid activities that put a lot of pressure on your arms or legs. People who are physically active should take special care to warm up before exercise and, if possible, avoid participating in activities for extended periods of time.
Stretching is always a must before and after physical activity and once you are done exercising, be sure to rest for a while before participating in any more physical exertion.
If you experience any type of pain or extreme pressure in your arms or legs during an activity, stop immediately. You should also immediately stop any activity if you begin experiencing tingling sensations or numbness. If this occurs while you are exercising, it is best to reduce the intensity of your exercise routine rather than pushing through where it could result in further injury. Seek medical attention right away if the symptoms persist after resting and icing the affected area.
Wear correctly fitted shoes
It is important to wear shoes that fit correctly and provide support when playing sports or engaging in strenuous physical activities. Compartment syndrome, a very serious condition where excessive amounts of fluid build up in an enclosed space in the body and can cause deformity or lead to other complications such as muscle or nerve damage, can be caused by wearing inadequate footwear that does not provide the necessary arch support for your feet.
Wearing shoes that are properly fitted for your foot size and type will help provide enough cushioning and support, reducing the chances of experiencing compartment syndrome. Footwear should also provide adequate space to avoid crowding your toes, which can increase strain on the muscles. Wearing socks and/or insoles may help absorb impact and strain on specific areas of feet while performing activities.
Conclusion
The outlook for compartment syndrome is generally good, especially if treated quickly and effectively. Your doctor will work with you to create a long-term treatment plan that addresses any underlying issues and helps you manage pain and working ability. In severe cases, surgery may be necessary to treat the issue. Physical therapy may also be recommended to strengthen muscles and enhance range of motion.
Most importantly, if you are experiencing symptoms of compartment syndrome or have other concerns about this condition, seek medical advice from an orthopedic specialist as soon as possible for diagnosis and treatment. With the help of your doctor, an individualized recovery plan can help you return to work or other activities safely following treatment.