What Is Compartment Syndrome?

Overview:

Compartment syndrome is a painful condition that needs medical treatment to avoid complications. The blog explains this condition in detail.

Compartment syndrome is a painful condition that is caused by an increase in pressure around the muscles. When the pressure increases, blood flow is restricted. As a result, the fresh oxygen and nutrients that the blood supplies to the muscles is affected.

What Is a Compartment?

The muscles, nerves and blood vessels are together called a compartment. The fascia, a fine but firm membrane, covers the compartment. In compartment syndrome, the increased pressure causes the compartment to rub against the fascia and this results in pain.

The condition commonly affects the legs, feet, arms, stomach and the backside. While these are the commonly affected parts, other parts too can get affected.

Compartment Syndrome – Types

There are two types in this condition:

• Acute: This type is of sudden onset and is usually due to an injury or a surgery complication. It needs emergency treatment as ignoring it or delaying treatment can have adverse effects like permanent muscle damage and paralysis.
• Chronic:This type builds up over time and is usually the result of exercising too intensively. As it happens due to over-exertion, it is also known as exertional compartment syndrome. While chronic compartment syndrome is not an emergency, it too requires medical treatment to get better.

Symptoms

The common symptoms are listed below:

• Muscle pain which is a lot more than what is usually experienced after a workout.
• Visibly swollen or bulging muscles.
• Muscle tightness, and pain while trying to stretch muscles.
• Reduced sensation in affected part.
• Burning sensation in the skin of the affected part.

Causes of Compartment Syndrome

Acute Type

• Road traffic accidents
• Fall from a height
• Fractured bones
• An injury caused by a falling heavy object
• Surgical complications
• A cast being too tight
• Sports injuries

Chronic Type

As mentioned earlier, this type builds gradually and is the result of over-exertion. When the same group of muscles are worked out repeatedly, pressure builds up and can result in chronic compartment syndrome. The activities that usually cause it include:

• Running
• Swimming
• Cycling
• Weightlifting

Risk Factors

• Anyone can develop acute compartment syndrome as it is usually the result of an injury.
• Athletes are at a higher risk of the chronic type.
• People who suffer from blood disorders are at a higher risk for developing compartment syndrome.

Complications

• Tissue death or necrosis is a serious complication of the condition. It results because reduced blood supply deprives the tissues of oxygen and they die.
• Fatalities from acute compartment syndrome have been reported and therefore, emergency treatment is a must for this type.

Diagnosis

The doctor will do a physical examination first. A detailed medical history will be recorded. It is important to let the doctor know if there is any particular activity that worsens or improves the condition. Other conditions with similar symptoms (like tendonitis) will also be ruled out.

The following tests may be advised:

• X-Ray: This helps determine fractures.
• Compartment Pressure Measurement Test:During this test, a needle is inserted into different parts of the affected area and the pressure is recorded by a machine that is connected to the needle.
• Repeat Pressure Test: In case of chronic compartment syndrome, a pressure test may be done twice – once before and once after exercise. A comparative reading will help with diagnosis.

Treatment

The treatment rendered depends on the type.

Acute

• This emergency condition usually needs surgery. The procedure is called fasciotomy.
• During the procedure, the surgeon will make a cut in the fascia to relieve pressure after which the cut will be closed.

Chronic

This type gets better with rest. It is best to avoid overworking the affected part in the future as well. The doctor may suggest the following to handle the pain and prevent future flare-ups.

• Painkillers may be prescribed for the pain. It is important to not continue taking the painkiller for more than ten days.
• A change in the exercise routine may be suggested. For example, switching to cross training which mixes up exercises and avoids working out the same part repeatedly may be advised. For runners, the doctor might suggest surfaces to avoid while running (like concrete).
• Physical therapy, which is important to strengthen and increase the flexibility of the affected part, will be advised. The physical therapist will also check if the exercises are being performed correctly and suggest modifications if needed.
• The option of orthotics may be suggested for those whose legs are affected. Shoe inserts are commonly advised to support feet and legs.
• However, if none of the above bring about relief, fasciotomy will be suggested to resolve the condition.

Recovery

Acute

• For the acute type, immediately after fasciotomy, the affected part is immobilized and kept elevated. Putting any weight on the area should be avoided.
• The use of assistive devices may be suggested.
• Physiotherapy is started after around 10 days. The purpose of physiotherapy is to strengthen the part and improve range of motion.
• Complete recovery from surgery may take up to 3 months.

Chronic

• For the chronic type, improvement will be gradual as it is necessary to find out what works for the patient.
• A combination approach of treatments and exercise modification is usually effective. Keeping pressure off the affected area will help hasten recovery.

Prevention

There is no way to avoid the acute type as it is usually the result of an injury. For the chronic type, the following tips may help in prevention:

• Avoid over-exercise – if you feel pain, stop.
• Increase exercise intensity gradually.
• Stretch before and after exercise.
• Don’t perform the same exercise routine everyday – mix it up so that your muscles get some rest.
• Avoid hard surfaces while working out.
• If a cast feels too tight, or if you feel pain in the cast in spite of taking painkillers, let your doctor know.

Compartment syndrome can be quite painful but with proper management the symptoms will get better. Recurrence in the acute type is rare but for the chronic type recurrence is a possibility. It is imperative to talk to the doctor about what activities can be safely done to avoid recurrence.