Compartment Syndrome

Compartment Syndrome occurs when the pressure in the muscles exceeds normal levels, causing pain and compression of blood vessels, which cuts off oxygen to the nerves and muscle cells. Without the oxygen supply, the nerves and muscle start getting damaged.

Compartment Syndrome can be either acute or chronic. In Acute Compartment Syndrome, this is a medical emergency as loss of blood supply to muscle and nerves can result in permanent damage. Chronic Compartment Syndrome is a less severe form that can occur from continuous exercise and is not considered a medical emergency.

ANATOMY

The grouping of muscle, nerves and blood vessels is called a compartment, and is present in arms and legs. Muscles, nerves, and blood vessels are enclosed in compartments by fascia. Because fascia is quite inflexible, any bleeding or swelling, such as that which occurs from bone or muscle trauma, will put pressure on structures within the compartment, thereby cutting off blood supply or damaging nerves.

CAUSES

Acute Compartment Syndrome: Causes of acute compartment syndrome are fracture, crush injuries, casts, tight bandages, anabolic steroid use or severe damage to muscle. It is usually after a motor vehicle accident or fall.

Chronic or Exertion-induced Compartment Syndrome: It is caused by exercise which produces pain and swelling. Mostly seen in athletes like runners, bikers, etc. Discontinuation of exercise relieves it.

SYMPTOMS

In both Acute and Chronic Compartment Syndrome, pain is a major symptom which gets worse with foot movement. In the chronic form, pain diminishes when exercise is stopped. Numbness and tingling are often experienced in both forms. The acute form can result in paralysis due to the death of muscle and neural tissue. Visible muscle bulging can be seen in chronic type.

DIAGNOSIS

Diagnosis is mainly through physical examination with measurement of elevated compartment pressure. Acute compartment syndrome is a medical emergency and needs emergency medical attention to prevent permanent damage. For diagnosis of chronic compartment syndrome, measuring pressure levels in muscle before and after exercise is important.

TREATMENT

Acute Compartment Syndrome is emergently treated by surgically cutting the fascia involved (fasciotomy) to relieve the pressure in the affected compartment. In Chronic Compartment Syndrome, a fasciotomy is only considered when symptoms do not improve after non-operative treatment. These include physical therapy, anti-inflammatory drugs, and modifying activities that bring about pain.

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