Definition

Compartment syndrome is a painful and potentially life-threatening condition where pressure increases within a compartment (a group of muscles, nerves, and blood vessels). This occurs due to bleeding or swelling within the enclosed muscle space.

Each muscle compartment in the arms and legs is surrounded by a thin but strong membrane called fascia. Fascia keeps the muscle tissue in place and does not stretch. Compartment syndrome occurs when pressure within the compartment rises to dangerous levels, restricting blood flow to the area. Since the fascia cannot expand, blood accumulates, causing the pressure to continue increasing. Without a stable supply of oxygen and nutrients, nerve and muscle cells can become damaged.

This condition typically affects the lower leg, foot, arm, or hand but can occur anywhere there are enclosed compartments. Compartment syndrome can lead to severe damage or even death.

There are two types of compartment syndrome: acute and chronic.

• Acute Compartment Syndrome:
• Occurs suddenly and is extremely painful, usually following a serious injury or fracture.
• Considered a medical emergency requiring immediate treatment.
• Can result in permanent muscle damage, disability, or death if untreated.

• Chronic Compartment Syndrome:
• Develops slowly, often appearing during or after repetitive exercise or intense activity (like running or cycling).
• Symptoms typically subside within a few minutes of stopping the activity.
• Not a medical emergency and does not cause permanent damage.

Causes

Compartment syndrome occurs when there is bleeding or swelling inside the compartment, which contains nerves, blood vessels, and muscles. As the bleeding or swelling increases, nerves and muscles are compressed. The causes of compartment syndrome differ depending on whether it is acute or chronic.

Acute Compartment Syndrome

This form is usually triggered by severe injury, such as a traffic accident or bone fracture. It rarely occurs after minor injuries. Common causes include:

• Severe trauma, such as being crushed under a heavy object.
• Splints or casts applied too tightly for an extended period.
• Burns, which can cause the skin to become thick, tight, and non-elastic.
• Sudden restoration of blood flow after surgery to repair damaged or blocked blood vessels.
• Rapid muscle growth due to steroid use.
• Rarely, acute compartment syndrome can occur without a clear injury.

Chronic Compartment Syndrome:

Chronic compartment syndrome is most commonly seen in people who exercise excessively or participate in sports that require repetitive movements. Examples of such sports include running, cycling, and swimming.

The exact cause remains unknown. However, it is believed that temporary swelling occurs in the muscles during exercise, interfering with blood flow to that muscle group.

Risk Factor

Several factors can increase your risk of developing compartment syndrome:

• Though it can affect people of all ages, it is most common in athletes under 30.
• Activities with repetitive motions, like running or cycling, increase your risk.
• Excessively intense or frequent physical activity also raises the risk.

Symptoms

Acute Compartment Syndrome

Symptoms usually appear after injury and can worsen quickly, including:

• Severe pain, especially when the muscle is stretched or used. The pain often feels far worse than expected based on the injury.
• Tight, swollen muscles that appear enlarged.
• Tingling or burning sensations in the skin.
• In severe cases, numbness or weakness may develop, indicating permanent damage.

Chronic Compartment Syndrome

This form progresses more slowly during exercise and improves with rest. Symptoms include:

• Pain or cramping during exercise that subsides when the activity stops, most commonly in the legs.
• Swelling or bulging muscles.
• Tingling sensations.
• The affected area may turn pale and feel cold.
• In severe cases, movement of the affected body part becomes difficult.

Diagnosis

In addition to asking about symptoms, recent injuries, activities, and medical history, the doctor will use several methods to diagnose compartment syndrome:

• Physical Examination
  The doctor will look for physical signs related to your condition.
• X-ray
  Imaging tests, such as X-rays, can help check for fractures or injuries to surrounding tissue.
• Compartment Pressure Measurement
  If compartment syndrome is suspected, a test to measure the pressure within the compartment is required. The doctor inserts a needle into the muscle at different locations, with a connected device measuring the pressure.
• Repetitive Pressure Testing
  For chronic compartment syndrome, pressure tests are repeated before and after exercise, and the results are compared.

Management

Complications

Acute compartment syndrome requires immediate treatment. If pressure within the compartment isn't reduced, it can cause:

• Muscle contractures (muscle stiffness and deformities)
• Permanent damage to muscles and nerves within 24 hours
• Permanent disability
• Amputation of the affected limb due to tissue death
• Death

Prevention

To prevent injury or accidents, drive carefully and wear protective gear during sports.

If you're wearing a cast, splint, or bandage that feels too tight, notify your doctor. The cast or splint may need adjustment to prevent compartment syndrome. Also, if you're taking pain relievers but continue to experience pain or swelling, pay close attention.

Meanwhile, you can prevent chronic compartment syndrome by:

• Gradually increasing the intensity of exercise to avoid sudden strain.
• Changing body position during workouts to avoid repetitive movements.
• Improving body flexibility.
• Avoiding overtraining muscles.
• Wearing proper footwear suited to the sport.

When to See a Doctor?

Acute compartment syndrome requires immediate attention. If you suspect you have acute compartment syndrome, seek medical help right away.

Acute compartment syndrome is a medical emergency and ideally requires hospital treatment within a few hours to prevent permanent muscle or nerve damage.

Chronic compartment syndrome is less serious than its acute counterpart, but it's still advisable to consult a doctor for a proper diagnosis.

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