Introduction
Compartment syndrome is a serious medical condition that occurs when increased pressure within a closed muscle compartment impairs blood flow and nerve function. This can lead to tissue damage and, if untreated, permanent loss of function or even limb loss. Compartment syndrome most commonly affects the lower leg or forearm but can occur in any muscle group surrounded by rigid fascia. Early recognition and urgent treatment are critical to prevent severe complications.
Causes
Compartment syndrome can be classified as acute or chronic, with different underlying causes:
- Acute Compartment Syndrome: Most often results from trauma, such as fractures, crush injuries, or severe bruising. Other causes include tight casts or bandages, burns, or bleeding disorders.
- Chronic (Exertional) Compartment Syndrome: Usually occurs in athletes due to repetitive exercise, leading to increased pressure during activity that resolves with rest.
Symptoms
The main symptoms of compartment syndrome include:
- Severe Pain: Intense pain that is out of proportion to the injury and does not improve with pain medication.
- Pain with Stretching: Increased pain when stretching the affected muscle group.
- Paresthesia: Numbness, tingling, or a “pins and needles” sensation.
- Pallor: Pale or shiny skin over the affected area.
- Paralysis: Weakness or inability to move the affected limb (a late sign).
- Pulselessness: Weak or absent pulse in the affected limb (a very late and ominous sign).
- Tightness or Swelling: The affected compartment may feel tense or firm.
Diagnosis
Diagnosis is based on clinical evaluation and, if needed, measurement of compartment pressures:
- Medical History: Review of recent injuries, symptoms, and risk factors.
- Physical Examination: Assessment of pain, swelling, sensation, movement, and pulses.
- Compartment Pressure Measurement: In uncertain cases, a special device may be used to measure the pressure within the muscle compartment.
- Imaging: Not usually required but may be used to assess underlying injuries.
Treatment Options
Acute compartment syndrome is a surgical emergency:
- Immediate Fasciotomy: Surgical procedure to cut open the fascia and relieve pressure, restoring blood flow and preventing tissue death.
- Removal of Constrictive Dressings: Any tight bandages, casts, or clothing should be removed immediately.
- Supportive Care: Pain management, intravenous fluids, and monitoring for complications.
- Treatment of Underlying Cause: Addressing fractures, bleeding, or other contributing factors.
Chronic (exertional) compartment syndrome is managed differently:
- Activity Modification: Reducing or changing activities that trigger symptoms.
- Physical Therapy: Stretching and strengthening exercises.
- Surgical Fasciotomy: May be considered if conservative measures fail and symptoms are severe.
Prevention
Preventive strategies focus on minimizing risk factors and early intervention:
- Prompt Treatment of Injuries: Early management of fractures, bruises, and other trauma.
- Avoid Tight Dressings: Ensure casts and bandages are not too tight.
- Awareness of Symptoms: Recognize early signs and seek immediate medical attention if symptoms develop.
Takeaway
Compartment syndrome is a medical emergency that requires urgent diagnosis and treatment to prevent permanent damage. If you experience severe pain, swelling, or numbness after an injury, seek immediate medical care. Early intervention can save function and prevent serious complications.