UNDERSTANDING COMPARTMENT SYNDROME: CAUSES AND TREATMENT

Compartment syndrome is a painful medical condition that occurs when pressure builds within a muscle compartment, leading to diminished blood flow and possible tissue damage. It can lead to lifelong debilitation if not treated promptly.^[1]

Muscle compartments are surrounded by membranes known as fascia. When there is excess pressure buildup within a compartment due to swelling, bleeding or inflammation, the muscles press against the fascia. This can compress nerves and blood vessels, reducing blood flow and causing tissue damage. Restricted blood flow deprives tissues of oxygen and nutrients, leading to tissue ischemia.

How Common is Compartment Syndrome?

Compartment syndrome is not common, affecting roughly 7 in every 100,000 people. It tends to occur in males more often and those who are physically active. People with tibial (shin) bone fractures stand a 1-10% chance of developing the syndrome. Common causes of the syndrome include injuries or repetitive physical activities.

Types of Compartment Syndrome

There are primarily two types of compartment syndrome:

• Acute Compartment Syndrome: A medical emergency that requires immediate treatment, often caused by trauma, fractures, burns, or casts.^[2]
• Chronic Exertional Compartment Syndrome: Occurs due to repetitive muscle tissue stress, commonly seen in athletes who participate in sports involving repetitive movements like running or cycling. Most common in the lower legs or shins, known as leg compartment syndrome.^[3]

Symptoms of Compartment Syndrome

This syndrome can give rise to various symptoms, which can vary depending on the affected compartment. However, six main symptoms commonly surface across all types, known as the "6 P's."

The "6 P's" of compartment syndrome are^[5]:

1. Pain: Pain is often described as severe and out of proportion to the injury.
2. Paresthesia
3. Pallor: Pale appearance of the skin, which follows when there is decreased blood flow to the affected region.
4. Pulselessness: The absence of a pulse occurs with blood vessel compression.
5. Paralysis: Nerve compression results in an inability to move the affected area.
6. Poikilothermia: The inability to regulate body temperature due to lowered blood flow to the affected area.

Specific symptoms vary depending on the affected compartment, such as abdominal pain in abdominal compartment syndrome and wrist pain in forearm compartment syndrome.

Other symptoms can vary according to the type^[6].

Acute Compartment Syndrome Symptoms:

• Sudden and rapid onset of symptoms
• Swelling and tightness in the affected compartment
• Numbness or tingling sensation

Chronic Exertional Compartment Syndrome Symptoms:

• Pain or cramping during exercise that goes away when you stop exercising
• Feeling of tightness or pressure in the affected area while exercising
• Swelling or bulging of the affected area during exercise
• Numbness or tingling in the affected region
• Weakness or difficulty moving the affected area
• Foot drop, or the inability to move the front part of the foot. Foot drop is typical in leg compartment syndrome.

These symptoms count as urgent warning signs. If you experience any of these symptoms, it is crucial to seek immediate medical attention.

Causes of Compartment Syndrome

The exact causes are unknown.^[7] During exercise, muscles expand with the fascia. In the acute type, the muscles rapidly swell due to injury. In the exertional type, the muscle expands over time. In both, the fascia does not expand to accomodate the muscles inside. This lack of accommodation leads to pain, swelling, and physical difficulties.

75% of cases are associated with bone fractures in the leg. Overuse, leg fractures, injuries, pressure, and cardiovascular problems can increase the risk by promoting muscle compartment trauma.

Minor injuries, such as shin splints or tendonitis, can lead to the syndrome if not treated promptly. It is critical to seek medical attention for any injury, no matter how minor it may seem.

Abdominal compartment syndrome is a rare form. Trauma, surgery, or medical conditions like pancreatitis or liver failure can lead to this type.

Risk Factors for Compartment Syndrome

Certain factors increase the risk, including:

• Bone fractures, especially tibial fractures
• Muscle trauma and prolonged muscle pressure
• Athletes under the age of 35 who engage in repetitive movements like running or cycling
• Physically demanding jobs like construction work or firefighting
• Health problems such as diabetes or peripheral artery disease
• Medical procedures like surgery or dialysis
• Certain medications, including anabolic steroids or blood thinners,
• Certain activities like overtraining, vigorous exercise, or weightlifting
• High blood pressure can cause extra tension in the blood vessels,

Prognosis and Complications

The prognosis for compartment syndrome relies on the severity and how long the patient receives care after onset.

If untreated, it can lead to acute complications, such as permanent muscle and nerve damage. Volkmann Ischemic Contracture^[8] is one such rare complication that may arise if not treated properly.

It can also cause tissue necrosis and potentially require amputation. Nerve impairment can result in loss of feeling or movement. Tissue ischemia has a significant impact on function and can cause long-term complications.

These complications can significantly impact an individual's function and quality of life. Therefore, prompt diagnosis, treatment, and recovery are crucial for the best outcomes.

Diagnosis of Compartment Syndrome

Diagnosis occurs with a physical exam and specific tests.^[9]

A healthcare practitioner will check for signs of the syndrome during a physical exam, such as pain, swelling, and decreased range of motion.

Specific tests for compartment syndrome include:

• Compartment pressure measurement: inserting a needle into the affected compartment and measuring the pressure within it to check for the syndrome.
• Imaging tests: X-rays, ultrasound, or MRI scans can eliminate other conditions and evaluate the severity of tissue damage.

Differential Diagnosis

Compartment syndrome is challenging to diagnose, as the symptoms are similar to other conditions, such as shin splints or tendonitis.

Seek prompt medical help if you experience symptoms, as an early assessment and intervention can prevent serious complications.

Treatment of Compartment Syndrome

The treatment for compartment syndrome depends on the type, severity, and timing.

Acute compartment syndrome is a medical emergency. The primary treatment is urgent fasciotomy which can often be life-saving and is required within 6 hours of onset.^[10] This surgical technique involves an incision in the fascia to relieve the pressure within the affected compartment.

A skin graft may cover exposed tissue and promote healing after a fasciotomy.

Chronic compartment syndrome treatment focuses on managing symptoms and reducing pressure within the affected compartment.

Non-surgical treatment options for chronic compartment syndrome include:

• Elevation of the affected limb
• Use of orthotics
• Physical therapy to reinforce the muscles and improve flexibility
• Implementing pain management techniques and medications

In some cases, antibiotics can help enhance outcomes if an infection is present.

If these conservative measures do not provide relief, a fasciotomy may be considered as a treatment option for chronic compartment syndrome as well.

It is important to note that the specific treatment method may vary depending on the individual case and the healthcare provider's recommendations. Therefore, consulting with a medical professional for an accurate diagnosis and appropriate treatment plan is crucial.

Recovery and Rehabilitation

After undergoing treatment for the syndrome, the rehabilitation process is necessary for a successful recovery.

Rehabilitation focuses on restoring the individual's overall physical function and quality of life. The person's unique needs may concern physical therapy, occupational therapy, and other specialized treatments.

Physical Therapy: Physical therapy is an integral part of rehabilitation. It helps restore the strength, flexibility, and function of the affected muscles and joints. Physical therapy exercises increase the range of motion and improve muscle strength gradually. A therapist will design a custom treatment plan based on the individual's needs and goals.

If acute compartment syndrome is not adequately treated or managed, there is a risk of developing chronic compartment syndrome.

Following the recommended treatment plan and taking necessary precautions to prevent recurrence is required. Follow-up care and regular check-ups with the healthcare provider can lower the risk of complications.

How long does recovery take?

In the best cases, it can take 3-4 months for a full recovery.^[11] In the worst cases, patients struggle to recover fully yet can often manage persistent symptoms.

Prevention:

Taking certain precautions and being aware of the risk factors is imperative to preventing compartment syndrome. Here are some practical tips for avoiding the syndrome:

1. Promptly seek medical attention for all injuries to prevent complications and reduce compartment syndrome risk.
2. Avoid prolonged limb pressure from tight casts or bandages to lower the risk of compartment syndrome.
3. Use proper workout techniques, avoid overtraining, and listen to your body for any symptoms of compartment syndrome.
4. Sustain a healthy lifestyle with a balanced diet, regular exercise, hydration, and proper nutrition to support muscle health and reduce compartment syndrome risk.

By following these tips and being aware of the risk factors, you can reduce the likelihood of developing this serious condition. It is always best to consult a healthcare expert for evaluation and guidance if you have any concerns or symptoms.

Conclusion

Compartment syndrome arises when increased muscle compartment pressure leads to tissue damage. Physically traumatic injuries are the most common cause of the condition, with the highest prevalence in young male athletes. Acute compartment syndrome requires urgent fasciotomy, while chronic compartment syndrome management revolves around non-surgical treatment options. With swift treatment and adequate rehabilitation, the outlook is promising.

To avoid complications, seeking urgent medical attention for a correct diagnosis and appropriate treatment plan is necessary.