Compartment syndrome occurs when blood supply is dramatically reduced to muscles in a closed body space, known as a compartment. Compartments are found in the hand, forearm, upper arm, abdomen, buttock, and leg. The muscles most frequently involved are those on the front of the lower leg or the palm side of the forearm.
A muscle group is surrounded by a tough, fibrous membrane called the fascia. Small blood vessels supply the muscle with oxygen and other essential nutrients. Insufficient blood supply to tissues and compartment syndrome can occur if: the muscle compartment size is reduced, as when a cast is too tightthe muscle compartment contents are increased, such as by swelling or bleeding associated with injury
If the affected muscles are deprived of blood supply for more than 6 hours, nerve and muscle tissue can be permanently damaged or destroyed.
The person will usually complain of increasingly severe, constant pain in the affected muscles. Often the degree of pain seems more than expected for the severity of the injury. Other symptoms of compartment syndrome include: decreased pulses below the affected areadifficulty making the muscle moveintense pain with stretching of the musclenumbness in the skinpale skinswelling and tenderness of the muscle
Intermittent compartment syndrome can occur. A runner with this condition may complain of tightness and aching in the calf muscles. The person may run a relatively short distance and need to stop due to discomfort. The tightness gradually goes away after the person stops running.
Some common causes of compartment syndrome include: bleeding, from a bone fracture or other injuriesburnscasts applied to treat bone fractures or other abnormalitiesa crush injuryintense exerciseleaking of intravenous fluid or injections into the compartmentrepeated use of a muscle groupseizures that involve the muscles in the compartmentsnakebiteswelling of the muscle itself
Acute compartment syndrome can sometimes be avoided by early stabilization of a fracture. This may involve splinting, elevating the injured limb on a pillow, and applying ice to reduce swelling.
If a person has a cast, circulation to the area below the cast needs to be checked frequently. If circulation is impaired or the person has severe pain, the healthcare professional may choose to cut the cast to relieve pressure.
Diagnosis of compartment syndrome begins with a medical history and physical exam. The raised pressure within the compartment can be measured with specialized instruments.
If compartment syndrome is untreated, death of the muscles can occur. Muscles can become inactive and excessively tight. Toes or fingers may become fixed in a curled position with permanent numbness. Severe tissue death may lead to the need for amputation of the affected limb.
Compartment syndrome is not contagious and poses no risk to others.
Diagnosis must be made accurately and promptly to assure a good outcome. Initial treatment consists of elevating the limb above the level of the heart. If a cast has been applied, it is removed.
In more severe cases, a surgical procedure known as a fasciotomy may be used to open the membrane leading to the affected muscles. Pressure is relieved, and the blood flow can return to normal. Often the skin needs to be left open for a few days. It can be closed with sutures or a skin graft after the swelling goes down.
Surgery can be complicated by bleeding, infection, or reactions to anesthesia. The muscle and nerves may not return to normal after recovery.
A scar may appear where the skin was left open following surgery.
Any new or worsening symptoms should be reported to the healthcare professional.