What is compartment Syndrome?
Compartment syndrome is a condition that occurs when
injury causes generalized painful swelling and increased
pressure within a compartment to the point that blood cannot
supply the muscles and nerves with oxygen and nutrients.
Muscles in the forearm, lower leg and other body areas are
separated by fibrous bands of tissues into compartments, and
this fibrous tissue is very inflexible and cannot stretch to
accommodate the generalized swelling. If left untreated,
muscles and nerves fail and may eventually die. As the
compartment syndrome progresses, the structures controlled
by the muscles and nerves inside the compartment may fail to
While most often occurring in the forearm and lower leg,
compartment syndrome can rarely occur in other parts of the
body that have muscles contained in compartments, including
the hands and feet.
Compartment syndrome may be acute due to swelling that
arises from injury, or it may be chronic because of exertion
usually from athletic exertion.
CAUSES - 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
- 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
Chronic (Exertional) Compartment Syndrome
The pain and swelling of chronic compartment syndrome is
caused by exercise. Athletes who participate in activities
with repetitive motions, such as running, biking, or
swimming, are more likely to develop chronic compartment
syndrome. This is usually relieved by discontinuing the
exercise, and is usually not dangerous.
DIAGNOSIS - Physical examination at rest often
provides little helpful information: you are unlikely to see
any abnormalities unless examining immediately postexercise.
It is vital to take a careful history, including training
regimes. You will need to establish the specifics of the
pattern of pain: how long after the start of exercise and at
what intensity it sets in; how and when it eases off again.
Passive stretching of the involved muscle after exercise
may increase your client’s pain. Over time you may notice
muscle atrophy, and the client may report tenderness and
increased tension in the involved compartment. But be
careful with differential diagnosis: tenderness directly
over the tibia is more likely to be a stress fracture,
tibialis posterior tendinitis or periostitis.
One further rare condition can present with almost
identical symptoms as chronic exertional compartment
syndrome (CECS) and must be excluded: popliteal artery
entrapment syndrome (PAES). This most frequently affects
young male athletes who describe exertional calf pain with
possible associated leg weakness and paraesthesia. PAES is
the partial or complete occlusion of the popliteal artery in
the popliteal fossa (back of the knee), secondary to
aberrant anatomy. Weaker distal pulses and poor capillary
refill of the extremity with exercise or with provocative
manoeuvres (repeated ankle dorsiflexion with knee extension)
and normal compartment pressures help differentiate PAES
from chronic exertional compartment syndrome (CECS).
Angiogram provides definitive evidence.
Coupled with a careful history, the gold standard for
chronic exertional compartment syndrome (CECS) diagnosis is
to measure the pressure within the affected compartment,
first at rest, then at several points while exercising, and
finally 5, 10 and 20 minutes after exercise. It is very
important that symptoms are elicited during this process and
measurements taken at intervals until the symptoms subside.
This is usually an outpatient procedure, requiring the
insertion of a pressure probe into the affected compartment.
Several non-invasive forms of investigation have been
assessed for reliability of diagnosis, including MRI.
TREATMENT - If compartment syndrome is suspected,
your health care provider will assess the pressure inside
the affected region using a special probe. If compartment
syndrome is diagnosed, surgery is generally required.
Surgeons will open the affected region and make incisions in
the fascia surrounding the swollen muscles. The wounds will
be left open and covered with sterile bandages for several
days until the swelling diminishes, at which time your
health care provider can close the surgical wounds.
Identification of compartment syndrome and prompt
treatment usually result in a good outcome. Failure to treat
compartment syndrome promptly may result in extreme pain, as
well as permanent damage to muscles and nerves, which may
even require amputation of the affected limb.