Definition
In many places in our body, our muscles are located together with nerves in so-called muscle boxes, a compartment in which they are separated from the environment by a tissue skin. We have most of the muscle compartments on our extremities, i.e. the arms and legs. Their main purpose is to enable the muscles to function smoothly. In compartment syndrome, increased tissue pressure occurs in a closed skin or soft tissue mantle of one or more muscle compartments, which leads to restrictions of the muscles and nerves within.
Forms of the compartment syndrome
The compartment syndrome can occur in an acute or chronic form. The lower leg is most frequently affected in both forms.
- 1 Acute compartment syndrome: Acute compartment syndrome occurs as a result of a traumatic injury, such as after a car accident or a broken bone.
The injury causes increased tissue pressure in the affected compartment, resulting in a reduced and insufficient blood supply to the muscles and nerves. Acute compartment syndromes are medical emergencies that must be surgically corrected as quickly as possible. Untreated, compartment syndrome leads to permanent damage to the muscles and nerves due to the lack of blood supply. In severe cases, the entire extremity can lose its function.
- 2 Chronic compartment syndrome: Chronic compartment syndrome (also known as load compartment syndrome or load-induced compartment syndrome) is a clinical picture induced by muscle training, whereby the strong enlargement of the muscles during training leads to greatly increased pressures within the compartment. The pressure generated by the muscles reduces the blood flow to the affected area, which leads to a lack of oxygen in the muscles.
Origin
In order for a compartment syndrome to develop, the affected musculature must be uninjured and functional. The tissues that surround the muscles in the compartments are not stretchable. Therefore, an increased amount of fluid leads to a strong increase in pressure in the entire compartment and thus on muscles and nerves.
If, as a result of a trauma, such as a broken bone, an impact trauma (bumper) or crushing injuries, the pressure in the compartment increases due to bleeding, reduction of venous return or the blood supply, a compartment syndrome can develop. Over-closed bandages or the closure of a connective tissue defect can also constrict a compartment and cause compartment syndrome if this causes an increase in pressure in the tissue. The chronic compartment syndrome is not preceded by any external injury, it is a stress-induced syndrome.
The basic mechanism is the same as in acute compartment syndrome, namely the compression of the supplying blood vessels of the muscles and nerves by pressure. In the case of chronic compartment syndrome, the enlargement of the muscles under stress plays a decisive role. Under heavy exertion, the size of the muscles can increase by up to 20%, which, due to the lack of elasticity of the surrounding tissue layer, squeezes the blood vessels supplying and discharging the muscles.
This results in a lack of oxygen, which first manifests itself in stabbing pain. The load-induced compartment syndrome often occurs in the lower legs of runners. Outside the training phases, the athletes are usually free of symptoms, only in the training phases the problem manifests itself.
Pain usually occurs during training and increases during the load. After training, the pain can last for several hours until the next day. The chronic compartment syndrome can also be caused by tissue swelling in the surrounding area, which compresses the vessels of the muscles and nerves and thus leads to a lack of supply and thus pain. In about 40% of all unclear cases of chronic compartment syndrome, muscle hernias caused by fascial defects can be detected.
All articles in this series:
