Compartment Syndrome: Causes, Symptoms & Treatment

Compartment syndrome is an increase in pressure in muscle tissue caused by injury or overuse, which can lead to the death of muscles and nerves. A distinction is made between the acute and chronic forms. Acute compartment syndrome is a life-threatening emergency and must be treated as soon as possible.

What is compartment syndrome?

Compartment syndrome is the increase in pressure in a muscle group. It leads to reduced blood flow and impaired nerve function. Muscles are surrounded by a sheath of connective tissue called fascia. This connects several muscles with the same function to form a muscle group called a compartment or lodge. The fascia lies tightly around the muscles and is not very stretchable. If a bruise or swelling develops in such a muscle group, the pressure within the compartment increases because the surrounding fascia does not yield. The increase in pressure constricts or squeezes nerves, tissues and blood vessels, causing damage or even destruction as the condition progresses. Compartment syndrome occurs most frequently in the forearm and lower leg. A distinction is made between acute and chronic compartment syndrome. The acute form should always be considered an emergency and requires immediate medical treatment.

Causes

There are many causes of compartment syndrome. Acute compartment syndrome is most commonly caused by injuries, such as broken bones, contusions, or bruises. This causes space-occupying bruising or edema (water retention), the fascia cannot give way and so the pressure in the compartment increases. Wounds that are sutured too tightly or a bandage that is too tight can also trigger acute compartment syndrome. In contrast to acute compartment syndrome, which develops in a very short time, the chronic form develops over a longer period of time. It occurs in athletes, especially long-distance runners or bodybuilders. When the muscle is over-trained, causing it to increase in volume in a very short period of time, the fascia is unable to adapt quickly enough. This type of condition is also called functional compartment syndrome.

Symptoms, complaints, and signs

Compartment syndrome usually does not cause acute symptoms or discomfort. However, depending on the cause, chronic health problems may develop. In acute compartment syndrome, the primary symptoms are severe pain, usually associated with a feeling of tightness and swelling in the affected area. Sensory disturbances and paralysis of the muscles also set in, and the paralysis symptoms can become chronic if not treated. The acute compartment syndrome often occurs on the lower leg and the dorsum of the foot. The chronic form is also manifested by pain and tightness in the affected area. It is typical for the disease that the symptoms do not occur permanently, but mainly during physical activity. At rest, the symptoms quickly subside. In addition, chronic compartment syndrome can lead to deformities, joint wear and tear, and other symptoms. Often, as a result of the restricted mobility, psychological complaints also arise, which require independent treatment. In the long term, compartment syndrome can lead to permanent muscle damage. The quality of life of those affected is severely limited, especially in the chronic form. If the condition is treated, the symptoms usually subside again or can at least be reduced to such an extent that the affected person can lead a relatively symptom-free life.

Diagnosis and course

The physician makes the diagnosis for compartment syndrome based on the patient’s symptoms and medical history. The acute form causes extreme pain as well as swelling, numbness, and tingling in the affected body part. The ability to move is limited, and the skin is pale and feels cold. In chronic compartment syndrome, there is also clearly visible swelling in the affected muscle group. However, the symptoms occur only under stress and subside as soon as the patient is at rest. By palpating the muscles and measuring pressure with a probe, the physician can test whether compartment syndrome is present. Sensitivity testing of the skin reveals both sensory disturbances and the area in which the compartment syndrome is located.Ultrasound and X-ray examinations are used as further diagnostic measures. Ultrasound can be used to detect tissue changes, and an x-ray will reveal any underlying bone fracture.

Complications

Compartment syndrome is a very serious injury that definitely needs to be treated by a doctor. As a rule, certain muscles or tissues in the body die in the process, so that there can be considerable restrictions in everyday life and movement. Those affected suffer from severe pain in the muscles. These can usually affect the patient’s entire body. The pain usually spreads to other regions of the body as well. Furthermore, pain at night often leads to sleep problems and thus to a general irritability due to the persistent fatigue. Muscles become paralyzed due to the compartment syndrome, resulting in tension throughout the body. It is not uncommon for patients to also suffer from the typical tingling sensation. Treatment of compartment syndrome is usually causal and symptomatic. In acute emergencies, surgical intervention can be performed. However, it cannot be guaranteed that irreversible consequential damage will not occur. If the compartment syndrome is already chronic, the symptoms can be reduced by reducing the load. This usually does not result in further complications.

When should you see a doctor?

Chronic compartment syndrome must be diagnosed and treated medically. Anyone who experiences recurrent muscle pain that cannot be attributed to any specific cause should seek medical attention. Movement restrictions, sensory disturbances and muscle weakness are further signs that indicate a serious condition and must be treated. Acute compartment syndrome also requires medical attention. If the sufferer feels severe pain or sensory disturbances in a particular area of the body, he or she should consult the family doctor the same day. Nonspecific symptoms must also be investigated if they persist for several days. Thus, with swelling and paralysis symptoms, medical advice should always be sought. Compartment syndrome mainly affects extreme athletes and people who have a physically demanding job. Those who belong to the risk groups are best advised to consult their family doctor immediately if they experience the symptoms mentioned above. Depending on the type and severity of the symptoms, a sports physician, an orthopedist or a specialist in internal medicine may also be consulted. Children are best taken to a pediatrician if they experience unusual muscle pain.

Treatment and therapy

Chronic compartment syndrome is relatively harmless; in most cases, a reduction in exertion is sufficient here to cause a regression of the pressure in the muscles. The affected body part should be positioned at heart level and cooled. Sports training should be discontinued. Once the pressure situation in the muscle has normalized, one can start exercising again with slow loading under medical supervision. Acute compartment syndrome, on the other hand, must be treated as quickly as possible, otherwise tissue may die and life-threatening multiple organ failure may result. If the increase in pressure was caused by a bandage that is too tight, it must be removed immediately. To reduce the pressure in the muscle compartment, a surgical procedure known as a fasciotomy is performed. This involves making an incision in the skin and fascia at the affected area to allow the muscles to yield to the pressure and expand. If muscle tissue is already dead, this is removed. After the swelling and pressure have subsided, the fascia and skin are sutured. Skin grafts may be necessary. If nerves and muscles have been damaged by the compartment syndrome, physical therapy training may help after the wounds have healed.

Outlook and prognosis

If the diagnosis of compartment syndrome is made promptly, professional treatment can also begin promptly. In this case, the prognosis is quite good. Often, compartment syndrome results from deep vein thrombosis in the legs, edema in the legs, or a fracture of the lower leg. Only rapid treatment allows the tissue pressure and the associated circulatory disturbance to be completely relieved. Permanent damage is not to be feared in this case. The mobility of the extremities is not permanently reduced.However, if the compartment syndrome remains untreated for a longer period of time, this can lead to a worse prognosis. A persistent circulatory disturbance in the musculature subsequently leads to the death of the surrounding muscle tissue. As a result, necroses form due to dying tissue. The scars in the affected muscles lead to more or less severe functional disorders. In the worst case, untreated compartment syndrome can lead to joint stiffness. If left untreated, compartment syndrome can also lead to paralysis. In this case, too, the prospects for improvement are rather small. It is true that patients with this symptomatology can receive physiotherapeutic treatment. However, this can only restore mobility to a limited extent in the damaged areas. Therefore, there can only be a good prognosis in compartment syndrome if the compression-related circulatory disorder is recognized and treated promptly.

Prevention

One can prevent against acute compartment syndrome by preventing circulatory disturbances and an increase in pressure. For injuries to the extremities, elevation can promote drainage of blood and inflammatory fluids. A drain, a surgically placed tube that allows blood and wound fluid to drain, is also helpful. Dressings that are too tight must be loosened. Chronic compartment syndrome can be prevented by proper exercise.

Aftercare

In most cases, aftercare for compartment syndrome proves to be relatively difficult, so the first priority for this condition is to see a doctor quickly to prevent further injury to the muscles and thus further complications. Self-healing cannot occur. If the symptoms occur, an emergency doctor should be contacted or a hospital should be visited immediately. In general, the affected area should no longer be stressed so that the muscles can recover. Bed rest should be observed, and affected individuals should not engage in strenuous, stressful or physical activities. The site should be immobilized so that it is no longer moved. Patients may be dependent on physiotherapy or physiotherapy measures due to the compartment syndrome. In this case, many of the exercises can also be performed in the patient’s own home, which may further accelerate the healing process. Only in a few cases are surgical interventions necessary. As a rule, the compartment syndrome can be treated relatively well again, and special aftercare is no longer necessary in this case. The disease also does not reduce the life expectancy of the affected person. Some patients are dependent on the help and support of friends or their own family in their daily lives due to the disease.

This is what you can do yourself

Whether self-help measures are useful for a present compartment syndrome depends primarily on the type and severity of the disease. If the condition is acute compartment syndrome, there is usually little that affected individuals can do themselves to relieve the symptoms. In this case, surgical intervention is often unavoidable. The situation is different in the case of chronic-functional compartment syndrome: Here, the patient should take it easy on the respective body area and cool it down. Cooling promotes decongestion. At the same time, however, it is advisable to promote circulation – for example, by elevating the legs. In consultation with the attending physician, moderate exercise in the aerobic range – that is, at a low heart rate – is possible and even beneficial for healing, because exercise provides the connective tissue with an optimal supply of nutrients. However, the patient should keep the strain on the body as low as possible, because: If the heart rate increases, as is the case with training in the anaerobic range, lactate (lactic acid) is formed. Lactic acid in turn leads to faster muscle fatigue and can significantly delay the healing process. The doctor treating the patient always decides whether sporting activity is appropriate in each individual case and, if so, to what extent.