Classification by localization

The lower leg is one of the most common localizations of a compartment syndrome. There are four muscle boxes in a rather limited space, each of which is separated by a thin, less flexible layer of connective tissue (fascia). A swelling in one of these compartments therefore quickly leads to a disturbance of the blood flow and thus to a compartment syndrome.

A distinction can be made between an acute occurrence, for example after an accident with a closed fracture, and a rather slow occurrence under physical stress (chronic compartment syndrome). The former represents a surgical emergency and must be operated on immediately, otherwise the leg can die and in the worst case, life may be in danger. The chronic compartment syndrome mainly affects athletes.

Through training (for example, jogging or playing soccer) the muscles increase in size and swell. Since the rigid fascia only yields to this increase in volume to a limited extent, pain in the affected lower leg can occur during physical exertion. This pain subsides again after the end of the exercise and by elevating and cooling.

In compartment syndrome of the lower leg, the foremost muscle lobe is most frequently affected (tibialis anterior).A nerve (nervus peroneus) running there is often squeezed, which leads to a temporary paralysis of the foot lifter muscles. This is known as tibialis anterior syndrome. The compartment syndrome on the calf is one of the compartment syndromes on the lower leg.

However, while the muscles of the front of the lower leg are most frequently affected, compartment syndrome of the calf is less common. The calf muscles consist of a superficial and a deeper compartment, each of which is separated by its own connective tissue fascia. In compartment syndrome of the calf, both muscle compartments or only one can be affected.

Since the calf muscles serve to lower the foot and provide stability to the leg, compartment syndrome causes severe pain, which usually makes walking and even standing impossible. If an accident causes swelling and tension pain in the calf, it may be necessary to split the affected loge in an emergency. If there is pain in the calves, which occurs when walking and disappears again when resting, the cause can also be a circulatory disorder due to arteriosclerosis (“window dressing”).

In addition, if there is pain in the calf, under certain circumstances thrombosis must also be considered (closure of a vein by a blood clot). Increasing or prolonged pain in the calf should therefore be promptly clarified by a doctor. On the foot, a fracture of the bone (e.g. the heel bone after a fall from a great height) can lead to compartment syndrome.

The many small muscle groups on the foot are divided into nine compartments, each of which is separated by tight connective tissue (fascia). In principle, any of the boxes can be affected by compartment syndrome. Often several are affected at once.

The consequence of an untreated compartment syndrome in the foot can be the death of the affected foot muscles due to insufficient oxygen and nutrient supply via the blood. This in turn can result in a claw malpositioning of the toes, which makes walking difficult or, in the worst case, impossible. For this reason, if a bone fracture occurs on the foot with increasing swelling and pain, a possible compartment syndrome should be considered and a tissue pressure measurement should be performed.

If necessary, the pressure can be relieved and the foot muscles saved by a timely minor operation. Compartment syndrome of the thigh is a disease that occurs only extremely rarely. There are only individual case reports of patients in whom compartment syndrome has developed as a result of serious accidents with bleeding into the thigh.

In contrast to the lower leg, for example, the muscle loops in the thigh are less tightly enclosed by connective tissue, so that swelling of the tissue is more likely to be tolerated and there is less chance of blood vessels or nerve tracts being shed. If a patient is nevertheless suspected of having compartment syndrome in the thigh, a tissue pressure measurement should be performed promptly. If the suspicion is substantiated, emergency surgery to split and relieve the pressure on the thigh may have to be performed.

The forearm is most frequently affected in compartment syndrome of the “upper extremity” (shoulder girdle, arms and hands). Here, three muscle boxes with many different muscles and tendons are located in a relatively small space. In particular, a forearm fracture (ulna, radius or both bones) can lead to compartment syndrome in one or more of these boxes.

As with the legs, the syndrome manifests itself through increasing tension pain, shiny and overstretched skin and, if necessary, paralysis and tingling of the hand due to nerve damage. This is a medical emergency that must be treated as quickly as possible by surgically splitting the affected compartment to relieve pressure. Otherwise, the muscles that have been squeezed off can die and there is a risk of malpositioning or even loss of function of the hand.