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Compartment Syndrome: Causes, Diagnosis, and Treatments

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Compartment syndrome occurs when pressure rises in and around muscles. The pressure is painful and can be dangerous. Compartment syndrome can limit the flow of blood, oxygen and nutrients to muscles and nerves. It can cause serious damage and possible death.

Compartment syndrome occurs most often in the lower leg. But it can also impact other parts of the leg, as well as the feet, arms, hands, abdomen (belly) and buttocks.

Compartment Syndrome

Are there different types of compartment syndrome?

There are two kinds of compartment syndrome:

  • Acute compartment syndrome is usually caused by a bad injury and is a medical emergency. Without treatment, acute compartment syndrome can permanently damage muscles. It can also lead to disability, paralysis or even death.
  • Chronic compartment syndrome usually isn’t an emergency. It’s often caused by physical exertion, such as intense exercise. Healthcare providers sometimes call it exertional compartment syndrome for that reason.

What is a compartment?

A compartment is a group of muscles, nerves and blood vessels. A thin but firm membrane (covering) called a fascia lies over each compartment. It keeps the muscles in place. But the fascia isn’t meant to stretch or expand much.

What causes compartment syndrome?

A serious injury or too much physical exertion can cause swelling or bleeding in a compartment. The fascia won’t expand to make room, so the swelling or bleeding puts pressure on the nerves and muscles. Healthcare providers call this compartmental pressure.

If the pressure gets too high, the tissues can’t get enough blood, which contains oxygen and nutrients. The tissues can die, leading to permanent damage to the area. These complications can also threaten your life.

What types of injuries can cause compartment syndrome?

Examples of injuries that can cause compartment syndrome include:

  • Badly bruised muscle.
  • Car accident.
  • Crush injury, such as when something falls on you.
  • Fracture (broken bone).
  • Sudden return of blood flow after something blocks circulation, such as surgery or loss of consciousness.

Anabolic steroids can also cause compartment syndrome by increasing muscle size too quickly. Other causes include casts or large bandages that are too tight and worn for a while.

What types of activities can cause exertional compartment syndrome?

Chronic compartment syndrome can happen when a person overtrains (exercises too much). Sports with very repetitive movements pose a particular risk. Examples include:

  • Biking.
  • Running.
  • Swimming.

What are the symptoms of compartment syndrome?

The symptoms of compartment syndrome can include:

  • Bulging or visible swelling of the muscle.
  • Feeling like the muscle is fuller, swollen or somehow larger than normal.
  • Numbness.
  • Muscle pain that is stronger than you’d expect from the injury.
  • Severe pain when you stretch the muscle.
  • Tightness in the muscle.
  • Tingling or burning sensation in or under your skin, called paresthesias.

How is compartment syndrome diagnosed?

If you think you have acute compartment syndrome, go to an emergency room right away. It’s a medical emergency that needs treatment. If you think you have exertional compartment syndrome, call your healthcare provider.

A healthcare provider will do a few things to diagnose compartment syndrome:

  • Physical exam: The healthcare provider will look for signs you might have something else. For example, the provider will check your tendons for tendinitis and your shins for shin splints.
  • X-ray: The healthcare provider may ask for an X-ray to see if you have a fracture.
  • Compartment pressure measurement test: If the provider suspects compartment syndrome, you’ll need a test to measure the pressure. The provider will insert a needle into the muscle. A machine attached to the needle will give the pressure reading. The healthcare provider may insert the needle in several different places.
  • Repeat pressure test: For exertional compartment syndrome, the test gets repeated after you exercise. The healthcare provider will compare before and after results.

How do you treat acute compartment syndrome?

Acute compartment syndrome must get immediate treatment. A surgeon will perform an operation called a fasciotomy. To relieve pressure, the surgeon makes an incision (cut) through the skin and the fascia (compartment cover).

After the swelling and pressure go away, the surgeon will close the incision. Sometimes that can’t happen right away. The surgeon may do a skin graft, taking skin from another area of your body to put over the incision.

How do you treat exertional compartment syndrome?

Exertional compartment syndrome usually goes away if you stop exercising. But you should still discuss it with your healthcare provider. Your provider may recommend:

  • Anti-inflammatory medications like non-steroidal anti-inflammatory drugs (NSAIDs).
  • Cross-training (mixing up exercise types, instead of doing the same thing over and over).
  • Low-impact exercise.
  • Orthotics (inserts for your shoes).
  • Physical therapy.
  • Softer surfaces for workouts (running on tracks instead of concrete, for example).

If those options don’t work, fasciotomy may be an option.

Can you prevent acute compartment syndrome?

You can’t prevent acute compartment syndrome caused by an accident or injury. But you can seek early diagnosis and treatment to prevent complications.

If you have a splint or cast that feels too tight, tell your healthcare provider. Pay particular attention if you’ve taken pain medication and that part of your body still hurts or swells. The cast or splint should get adjusted to prevent compartment syndrome.

Can you prevent chronic compartment syndrome?

You can prevent exertional compartment syndrome by:

  • Building exercise endurance gradually, instead of doing too much too soon.
  • Changing your body positions when you exercise (for example, mixing up your gait when you run).
  • Improving flexibility.
  • Not overtraining your muscles.
  • Wearing proper shoes.
  • Working out on softer surfaces that are easier on your body.

What happens if you don’t treat acute compartment syndrome?

Acute compartment syndrome needs immediate treatment. If the pressure isn’t relieved quickly, the condition can lead to:

  • Muscle contracture (rigidity and deformity).
  • Permanent damage to muscles and nerves, within 24 hours.
  • Permanent disability.
  • Amputation.
  • Death.

Does compartment syndrome come back?

Acute compartment treated with fasciotomy usually doesn’t come back. But chronic compartment syndrome can return if you start intense or repetitive exercise again.

How can you manage chronic compartment syndrome?

Rest and changes to your exercise routine may help relieve exertional compartment syndrome. But symptoms may come back, especially if you return to intense or repetitive activity.

Call your healthcare provider if pain gets worse over time or does not feel better with rest.

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