Compartment Syndrome: Causes, Symptoms, Diagnosis And Treatment

When excessive pressure builds up inside an enclosed muscle space in the body, it leads to a condition known as compartment syndrome ^[1] . This condition usually occurs due to bleeding or swelling after an injury. At times, this condition can be an emergency that would require immediate surgery to prevent permanent injury.

Compartment syndrome is an extremely painful condition. The build-up of pressure within the muscles can go beyond dangerous levels causing a decrease in blood flow, that would, in turn, prevent nourishment and oxygen from reaching nerve and muscle cells ^[2] .

Read on to know more about the symptoms, diagnosis and treatment of this condition.

What Is Compartment Syndrome?

The muscles in the forearm, lower leg and other body areas are surrounded by fibrous bands of tissues. This creates distinct compartments ^[3] . The fibrous tissue tends to be quite inflexible and so cannot stretch to accommodate swelling in the region (for instance, due to an injury). If left untreated, the muscles and nerves here would fail and eventually die. At times, compartment syndrome can also be chronic, that is because of exertion such as exercise.

Compartment syndrome can be of the following two types:

• Acute compartment syndrome: This is a medical emergency that is usually caused by a severe injury. If left untreated, it can lead to permanent muscle damage ^[4] .
• Chronic compartment syndrome ^[5] : This is also known as exertional compartment syndrome. Most of the time, it is not a medical emergency. It is usually caused by athletic exertion.

Causes Of Compartment Syndrome

After an injury, oedema or blood may accumulate in the compartment ^[6] . The walls of the fascia are tough and cannot easily expand, leading to a rise in compartment pressure ^[6] . This prevents adequate blood flow to tissues inside the compartment. Such cases can lead to heavy tissue damage. The arms, abdomen and legs are most prone to developing compartment syndrome.

Acute compartment syndrome is the most common kind and usually caused due to a broken leg or arm. This condition rapidly develops over hours or days. This condition can also occur without bone fractures and usually occurs due to the following issues ^[7] :

• Burns
• Crush injuries
• A blood clot in a blood vessel
• Overly tight bandaging
• Prolonged compression of a limb (especially during a period of unconsciousness)
• Surgery of blood vessels in the arm or leg
• Extremely vigorous exercise
• Taking anabolic steroids

Chronic compartment syndrome takes days or weeks to develop. It is usually caused by regular, vigorous exercise. In this condition, the thigh, buttock and lower leg are usually involved ^[8] .

Abdominal compartment syndrome usually occurs after a severe injury, surgery or critical illness. Some other conditions associated with this form are as follows ^[9] :

• Abdominal surgery (such as liver transplant)
• Trauma
• Sepsis
• Severe abdominal bleeding
• Pelvic fractures
• Vigorous eccentric abdominal exercises

Symptoms Of Compartment Syndrome

The symptoms of acute compartment syndrome include the following ^[10] :

• A new and persistent ache in the arm or leg
• The ache begins to come in a few hours after a serious injury
• The pain that seems greater when compared to the severity of the injury
• Tightness, swelling and bruising in the affected area
• Numbness, pin-pricking pain in the limb

The symptoms of chronic compartment syndrome include the following ^[11] :

• A feeling that resembles that of shin splints
• Worsening cramping in the affected muscle
• Signs that show within a half-an-hour of starting an exercise
• The aches that seem to reduce with rest
• Muscle functionality does not seem affected

The symptoms of abdominal compartment syndrome are usually not noticed by the patient (as he or she is mostly critically ill when this condition occurs). Doctors or family members might notice the following symptoms ^[12] :

• Wincing when the abdomen is pressed
• Slowed down urine output
• Low blood pressure
• A tense, distended abdomen

Diagnosis Of Compartment Syndrome

A doctor is likely to diagnose compartment syndrome based on the following:

• The patient's description of symptoms
• A physical examination
• The type of injury

In some cases, there needs to be a direct measurement of pressures inside the body compartment. To perform this, your doctor would insert a needle into the suspected region and an attached pressure monitor would record the pressure simultaneously ^[13] . Sometimes, a plastic catheter can also be inserted to monitor the compartment pressure continuously.

If abdominal compartment syndrome is suspected, then a pressure monitor is inserted into the bladder through a urinary catheter. If there are high pressures in the bladder, then it mostly suggests the presence of compartment syndrome ^[14] .

Laboratory and imaging tests can be performed to support the diagnosis of compartment syndrome.

Treatment For Compartment Syndrome

The focus of treatment is reducing the dangerous pressure in the body compartment. The casts or splints that constrict the affected body part are removed.

People with acute compartment syndrome might require immediate surgery to reduce compartment pressure. A long incision is made through the skin and the fascia layer underneath to release the pressure ^[15] . The other supportive treatments for this form include the following ^[16] :

• To improve blood flow into the compartment, keep the affected body part below the level of the heart.
• Oxygen can be given to the patient through the nose or mouth.
• Fluids are given intravenously.
• Pain medications can be prescribed.

Chronic compartment syndrome is first treated by avoiding the activity that had caused it. Stretching and physical therapy exercises can follow. Although surgery is not urgent in case of the chronic form, it might be opted to relieve pressure.

In the case of abdominal compartment syndrome, treatment includes life-support measures such as vasopressors, dialysis, mechanical ventilation, etc ^[17] . In some cases, the abdomen might need to be opened up to reduce the pressure.

Prevention Of Compartment Syndrome

In the case of acute compartment syndrome, early diagnosis and treatment can prevent further complications. However, there is no definite way to prevent this condition. For people who suffer from chronic compartment syndrome, wearing the right shoes, improving flexibility and altering gait pattern while running can go a long way in decreasing the severity of this painful condition.