Compartment Syndrome Overview
Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Compartment syndrome can be either acute or chronic. Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage. Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.
Types of Compartment Syndrome
Acute Compartment Syndrome This type of compartment syndrome typically occurs following a major injury. In rare cases, it also can develop after a minor injury. You can 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 (one of your blood vessels may become blocked while you’re sleeping or lying down after passing out)
Chronic (Exertional) Compartment Syndrome Exercise, especially when it involves repetitive motion, causes this type of compartment syndrome. Although it occurs most frequently in people under 40, 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 also increase your risk. The link between exercise and this condition isn’t fully understood. However, possible causes include:
- the way you move when doing certain activities
- having fascia that is thicker than normal
- having enlarged muscles
- having a high amount of pressure in your veins
Symptoms of Compartment Syndrome
The pain and other symptoms associated with chronic exertional compartment syndrome may be characterized by:
- Aching, burning or cramping pain in the affected limb usually the lower leg
- Tightness in the affected limb
- Numbness or tingling in the affected limb
- Weakness of the affected limb
- Foot drop, in severe cases, if nerves in your legs are affected
- Occasionally, swelling or bulging as a result of a muscle hernia
Pain due to chronic exertional compartment syndrome typically follows this pattern:
- Begins soon after you start exercising the affected limb
- Progressively worsens as long as you exercise
- Stops within 30 minutes after the affected limb comes to rest
- Over time, may begin to persist longer after exercise, possibly lingering for a day or two
Taking a complete break from exercise or performing only low-impact activity may relieve your symptoms, but usually only temporarily. Once you take up running again, for instance, those familiar symptoms usually come back.
Cause of Compartment Syndrome
Acute Compartment Syndrome Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury. Conditions that may bring on acute compartment syndrome include:
- A fracture.
- A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg with another player’s helmet.
- Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.
- Crush injuries.
- Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.
- Constricting bandages. Casts and tight bandages may lead to compartment syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.
Diagnosis of Compartment Syndrome
Your doctor will give you a physical exam to check for signs of acute or chronic compartment syndrome. For example, he or she may squeeze the injured area to determine the severity of your pain. Your doctor will also use a pressure meter with a needle attached to measure how much pressure is in your compartment. Your doctor needs to take the while you’re performing the activity that makes your leg or arm hurt, and again after you have finished. You might also have X-rays taken to rule out other conditions.
Risk factors of Compartment Syndrome
Certain factors increase your risk of developing chronic exertional compartment syndrome, including:
- Age. Although people of any age can develop chronic exertional compartment syndrome, the condition is most common in athletes under 30.
- Type of exercise. Exercise that involves repetitive impact activity such as running or fast walking increases your risk of developing the condition.
- Overtraining. Working out too intensely or too frequently also can raise your risk of chronic exertional compartment syndrome.
- Certain drugs. Taking anabolic steroids or the supplement creatine may increase the water content and mass of a muscle segment, contributing to the development of chronic exertional compartment syndrome.
Treatment for Compartment Syndrome
Acute Compartment Syndrome Surgery is the only treatment option for this type of compartment syndrome. It 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. If you developed this condition because of a cast or tight bandage, it will need to be removed or loosened. Chronic Compartment Syndrome Your doctor might try nonsurgical treatment methods first. These include:
- physical therapy to stretch the muscle
- shoe inserts (orthotics)
- anti-inflammatory medication
- changing the type of surface on which exercise is performed
- performing low-impact activities as part of the exercise routine
If these methods don’t work, you may need surgery. This would involve making a small incision into the fascia or removing part of the fascia to relieve pressure. Surgery is generally more effective than nonsurgical methods for treating chronic compartment syndrome.