Compartment syndrome
Compartment syndrome is a medical condition characterized by increased pressure within a confined space in the body, typically affecting the limbs and abdomen. This pressure can arise from injuries, excessive exercise, or other factors that lead to fluid accumulation in muscle compartments, which are surrounded by inflexible fascia. There are two main types: acute and chronic. Acute compartment syndrome often follows significant trauma, such as fractures, and can develop rapidly, leading to severe pain, numbness, and potentially irreversible tissue damage if not treated promptly. Chronic compartment syndrome, on the other hand, usually occurs due to repetitive activities in athletes and develops more gradually, with symptoms like muscle cramping that subside after exercise.
Diagnosis involves measuring compartment pressure, while treatment for acute cases typically requires emergency surgery known as fasciotomy to relieve pressure and restore blood flow. Chronic cases may be managed with physical therapy and activity modification, but some individuals may also require surgical intervention. Understanding and recognizing the symptoms early is crucial, as failure to address acute compartment syndrome can lead to serious complications, including muscle loss and the need for amputation.
Subject Terms
Compartment syndrome
Compartment syndrome is a medical condition in which pressure builds in a compartment, which is a space in the body that houses muscles, blood vessels, and nerves. It is usually caused by an injury. The walls of the compartments are lined with a strong connective tissue called fascia. The fascia is not very flexible, so when an injury occurs, blood and other fluids pool in the compartment. This causes the compartment pressure to rise and prevents blood flow to and from the tissues. The serious condition can result in permanent tissue and nerve damage, loss of muscle function, amputation, and even death.
Background and Symptoms
Compartment syndrome is most likely to affect the legs, arms, and abdomen. It is caused by injury, excessive exercise, or taking anabolic steroids. Physicians do not fully understand the link between vigorous exercise and compartment syndrome.
Two types of compartment syndrome exist: acute and chronic. Acute compartment syndrome generally occurs after a major trauma; however, a minor injury also can cause it. The majority of acute compartment syndrome cases are caused by a broken leg or arm. Other causes include bone fractures, severe bruising to the muscles, tight casts or bandages, prolonged compression of the limbs, blood clots, and injuries that crush the arms or legs. People who drink alcohol excessively or take drugs, including anabolic steroids, are more prone to developing acute compartment syndrome. This type usually occurs very rapidly, within hours of an injury. Symptoms include severe achiness, intense pain, numbness, feelings of pins-and-needles or electricity in the limbs, swelling, bruising, and tightness.
Acute compartment syndrome of the abdomen usually occurs from a severe injury or surgery. It also can be caused by organ transplants, especially liver transplant; trauma; shock; burns; sepsis, a serious and sometimes life-threating condition caused by an infection in the body; ascites, the accumulation of fluid in the abdominal cavity; abdominal bleeding; fracture of the pelvis; and excessive abdominal exercises such as sit-ups. Many times, it affects people who are critically ill and on life support. Compartment syndrome of the abdomen can cause permanent damage to vital organs such as the bowels, kidneys, liver, and intestines. Symptoms include distended belly, severe pain in the abdomen, slowed or stopped urine output, and low blood pressure.
Chronic compartment syndrome, also known as exertional compartment syndrome, usually is caused by excessive and frequent exercise that involves repetitive movements. It affects the lower legs, buttocks, or thighs. Athletes, who regularly play tennis, swim, or run, and are under the age of forty years old, are at an increased risk for developing this type of compartment syndrome. Chronic compartment syndrome is not as serious as acute compartment syndrome. It usually takes longer to develop and can occur over days or weeks. Symptoms include aching and cramping of muscles that begins when exercising and gets gradually worse as a person continues the activity. The pain usually disappears within a few minutes of stopping the activity.
Diagnosis and Treatment
Acute compartment syndrome is an emergency, and prolonged diagnosis may cause irreversible damage. The pressure must be released within a few hours of the symptoms to prevent permanent damage or even amputation. Patients who complain of pain, numbness, and weakness at the site of leg or arm injuries should be assessed for acute compartment syndrome. Casts and bandages should be removed. A physician should measure the pressure inside the affected compartment by inserting a needle outfitted with a pressure monitor.
Immediate surgery is the only treatment for acute compartment syndrome. A fasciotomy, in which the fascia is cut or removed to relieve the pressure and restore blood flow, is performed on the affected compartment. A patient can experience complications related to acute compartment syndrome, including muscle loss, infection, nerve damage, and even amputation of the affected limb in extreme cases. Aftercare includes elevating the affected area to improve blood flow, supplemental oxygen, intravenous fluids, and pain medication.
Acute compartment syndrome of the abdomen is usually more serious than other cases of compartment syndrome. A physician can detect pressure in the abdomen by inserting a urinary catheter with a pressure meter into the bladder. Surgery is typically the only option for these cases, but it may cause other serious complications.
Diagnosing chronic compartment syndrome sometimes is difficult because shin splints and small bone fractures can mimic symptoms of the condition. A physician will first perform a physical exam, usually after a person has exercised and begun to experience symptoms. This helps the doctor look for any herniation (muscle bulges), tenderness, or tension near the location of the pain.
If chronic compartment syndrome is suspected, a physician will measure the pressure inside the compartment of the affected area. Magnetic resonance imaging (MRI) may be used to scan the muscles in the compartments of the legs. A special type of MRI used while a person exercises can be used to assess fluids in the compartments during activity. This test is usually very accurate in detecting chronic compartment syndrome. Near infrared spectroscopy (NIRS), which uses light wavelengths to measure oxygen in the blood, may be used to determine if a compartment has decreased blood flow.
Several treatments exist to manage chronic compartment syndrome, including stretching, massage, physical therapy, pain medications, elevating and icing the affected area, avoiding high-impact exercises, and extending rest periods between exercising. Many individuals learn to manage the condition and alter their activities so as not to aggravate symptoms. In rare cases, people may opt for a fasciotomy to relieve pain.
Bibliography
"Chronic Exertional Compartment Syndrome." Mayo Clinic, 12 Feb. 2016, www.mayoclinic.org/diseases-conditions/chronic-exertional-compartment-syndrome/home/ovc-20182611. Accessed 15 Dec. 2016.
"Compartment Syndrome." MedlinePlus, 8 Sept. 2014, medlineplus.gov/ency/article/001224.htm. Accessed 15 Dec. 2016.
"Compartment Syndrome." Runner's World, www.runnersworld.com/tag/compartment-syndrome. Accessed 15 Dec. 2016.
"Compartment Syndrome." WebMD, 20 Oct. 2016, www.webmd.com/pain-management/guide/compartment-syndrome-causes-treatments. Accessed 15 Dec. 2016.
Delgado, Amanda. "Compartment Syndrome." Healthline, 7 Dec. 2015, www.healthline.com/health/compartment-syndrome. Accessed 15 Dec. 2016.
Rasul, Abraham T., Jr. "Acute Compartment Syndrome." Medscape, 6 May 2016, emedicine.medscape.com/article/307668-overview?pa=YSOhitp%2B18eQELlM9tPlI9Yn25vsJxXrGkMrDBaz7IVmzGHKGd%2FOY0qeLKFKMVsnt49R7EXkWuPAcO6y8ALUHXf7Bj2Gvk6BKC47oRZ1BB8%3D. Accessed 15 Dec. 2016.
Rowdon, Gregory A. "Chronic Exertional Compartment Syndrome." Medscape, 8 Oct. 2015, emedicine.medscape.com/article/88014-overview. Accessed 15 Dec. 2016.
Wedro, Benjamin. "Compartment Syndrome." MedicineNet.com, 25 Aug. 2016, www.medicinenet.com/compartment‗syndrome/article.htm. Accessed 15 Dec. 2016.