What is Compartment Syndrome?

Compartment syndrome is a serious condition that occurs when the pressure in a muscle compartment builds to dangerous levels.

Various muscular areas of our body are sectioned off into compartments. Fascia, a strong connective tissue with limited ability to expand surrounds many different groups of muscles. Similar to the idea of a sausage with its skin, the muscle tissue is contained in a compartment. On occasion, injury within the compartment can cause increased pressure. This is a compartment syndrome. It is characterized by increased pressure within a compartment that won’t expand.

The compartments are groups of muscle tissue, blood vessels, and nerves in your arms and legs surrounded by a very strong membrane called the fascia. Fascia does not expand, so swelling in a compartment can result in an increase in pressure inside the compartment. This results in injury to the muscles, blood vessels, and nerves inside the compartment.

The increase in pressure can cut off blood flow to the compartment. This can result in loss of oxygen going to the tissues (ischemia) and cellular death (necrosis).

Types of Compartment Syndrome

Acute Compartment Syndrome

This type of compartment syndrome typically occurs after you experience a major injury. In rare cases, it can also develop after a minor injury. For example, you may develop acute compartment syndrome:

  • following a fracture
  • after an injury that crushes your arm or leg
  • as a result of a severely bruised muscle
  • from wearing a cast or tight bandage
  • from heavy drinking or drug use

Chronic (Exertional) Compartment Syndrome

Exercise, especially when it involves repetitive motion, can cause this form of compartment syndrome. It occurs most frequently in people under 40, but you can develop it at any age.

You’re more at risk for developing chronic compartment syndrome if you do activities such as swimming, playing tennis, or running. Intense or frequent workouts can also increase your risk.

The link between exercise and chronic compartment syndrome isn’t fully understood.

Causes of Compartment Syndrome

Compartment syndrome can develop when there’s bleeding or swelling within a compartment. This can cause pressure to build up inside the compartment, which can prevent blood flow. It can cause permanent damage if left untreated, as the muscles and nerves won’t get the nutrients and oxygen they need. Not treating the condition may lead to amputation.

Symptoms of Compartment Syndrome

Acute Compartment Syndrome

The most common symptom of acute compartment syndrome is severe pain that doesn’t improve after keeping the injured area elevated or taking medication. Your leg or arm may feel worse when you stretch it or use the injured muscle.

Other symptoms may include a feeling of tightness in the muscle or a tingling or burning sensation in the skin around the affected area.

Symptoms of advanced acute compartment syndrome can include numbness or paralysis. This is usually a sign of permanent damage.

Chronic Compartment Syndrome

Pain or cramping when you exercise is the most common symptom of chronic compartment syndrome. After you stop exercising, the pain or cramping usually goes away within 30 minutes. If you continue to do the activity that’s causing this condition, the pain may start to last for longer periods.

Other symptoms may include:

  • having trouble moving your foot, arm, or affected area
  • numbness
  • a noticeable bulge in the affected muscle

Complications of Compartment Syndrome

Acute Compartment Syndrome

Acute compartment syndrome requires immediate medical attention to relieve pressure. Permanent damage to your muscles and nerves can develop within hours. This is a surgical emergency and could necessitate an amputation if not addressed immediately.

Chronic Compartment Syndrome

Chronic compartment syndrome isn’t considered an emergency, but you should let your doctor know if you’re experiencing any symptoms. Don’t try to exercise when you’re in pain, as this can cause permanent damage to your muscles, blood vessels, and nerves.

Diagnosis of Compartment Syndrome

Your doctor will give you a physical exam to check for signs of acute or chronic compartment syndrome. They may squeeze the injured area to determine the severity of your pain.

Your doctor may also use a pressure meter with a needle attached to measure how much pressure is in the compartment. This measurement needs to be taken while you’re doing the activity that makes your leg or arm hurt. It will be taken again after you’ve finished.

Your doctor may take X-rays to rule out other conditions.

Treatment of Compartment Syndrome

Acute Compartment Syndrome

Surgery is the only treatment option for this type of compartment syndrome. The process involves cutting open the fascia to reduce the pressure in the compartment. In severe cases, your doctor will have to wait for the swelling to go down before closing the incision, and some of these wounds require skin grafting.

If you developed this condition because of a cast or tight bandage, the material will need to be removed or loosened.

Chronic Compartment Syndrome

Your doctor may recommend nonsurgical treatment methods first, including:

  • elevating the extremity
  • resting after activity or modifying the activity
  • changing the type of surface you exercise on
  • icing the extremity after activity
  • physical therapy to stretch the muscle
  • anti-inflammatory medication
  • performing low-impact activities as part of your exercise routine

If these methods don’t work, you may need surgery. Surgery is generally more effective than nonsurgical methods for treating chronic compartment syndrome.