Compartment syndrome

Compartment-syndrome

Compartment syndrome

by Liz Morris, ATC

History
Compartment syndrome is a condition in which the pressure in the soft tissues of a limb is abnormally high, resulting in diminished blood flow to the affected extremity. Muscle groups in the arms, hands, legs, feet, and buttocks can be affected. Compartment syndrome can occur after trauma to an extremity or be brought on by exercise. Within these muscle groups are nerves and blood vessels. The muscle groups are covered by tough membrane (fascia), which does not readily expand. This fascia wraps around the muscle and contains it. In most cases, the fascia has enough room to allow the muscle to function without difficulty. The entire unit surrounding the muscle is called a compartment. The increase in fluid within a compartment causes increased pressure. This leads to compression of the blood vessels and compromises blood flow to the area. If not treated immediately, compartment syndrome can cause nerve and muscle damage.

Compartment syndrome can be either acute or chronic. Acute compartment syndrome is a medical emergency and without treatment can lead to paralysis, loss of the affected limb, or in extreme cases, death. Chronic compartment syndrome is more common and is not an emergency.

Acute Compartment Syndrome
A traumatic injury, such as a fracture, can often trigger acute compartment syndrome. Acute compartment syndrome may take several hours to develop. Swelling and bleeding at the injured site create pressure on capillaries and nerves within the muscle compartment. When the pressure in the compartment exceeds the blood pressure within the capillaries, the capillaries will collapse disrupting the blood flow to muscle and nerve cells. Without a steady supply of oxygen and nutrients, these cells begin to die within hours. This can cause permanent disability or death unless the pressure is relieved quickly .Other conditions may cause acute compartment syndrome include:
• A severely bruised muscle, when a football player receives a strong blow to the thigh from another player’s helmet
• A complication after surgery
• Blockage of circulation, such as from pressure over a blood vessel for too long while asleep
• A crush injury

Chronic Compartment Syndrome
Chronic compartment syndrome is characterized by pain and swelling due to exercise and can be a significant problem for athletes. Chronic compartment syndrome typically occurs in the legs, over the front of the shin. Unlike acute compartment syndrome, people suffering from chronic compartment syndrome experience pain after a period of activity or exercise but are quickly relieved by rest. It can also be accompanied by numbness or difficulty moving the foot.
Chronic compartment syndrome is due to a pressure build-up within the muscles of the leg. When activity levels increase, blood flow to a muscle increases, therefore the size of the muscle increases. In most people, the fascia allows adequate room to accommodate this increase in muscle size during exercise. However, in people with chronic compartment syndrome, the fascia is too tight, constricting the muscle during activity.

Symptoms
A combination of signs and symptoms characterize compartment syndrome. The classic sign of acute compartment syndrome is pain, especially when the muscle is stretched.
Symptoms of compartment syndrome include the “7 P’s”:
• Pain at rest
• Pain with passive stretch
• Pressure
• Parasthesia (tingling and numbness)
• Paresis (weakness)
• Pulse (diminished pulse in the affected limb)
• Pallor (loss of normal color)

Diagnosis & Treatment
Diagnosis can be made by measuring the pressure within the muscles of the leg. A pressure measurement is made at rest, and then after a person completes an activity (such as a quick run) that reproduces the pain. Once the repeat measurement is made, the pressure change is compared. In most cases the pressure difference from rest and activity is small. In people with chronic compartment syndrome there will be a dramatic increase in pressure readings when the symptoms are present after exercise.
Nonsurgical treatment is usually not effective for this condition but may include:
• Avoiding activities that cause pain and swelling
• Applying ice and elevating the limb slightly
• Taking ibuprofen to reduce inflammation
• Increasing cushioning in shoes

Do not wrap the leg because this will increase the pressure and aggravate the condition.
Surgical treatment may be necessary if the diagnosis of chronic compartment syndrome is clear and the symptoms persist. The surgery involves the release of the tight fascia, called a fasciotomy. An incision is made over the affected area, and then the surgeon cuts the tight tissue that surrounds the muscle. This reduces the pressure in the compartment.

References:
Cluett, J. (2008).Exertional compartment syndrome what is exercise induced compartment syndrome? Retrieved November 12, 2008 from http://orthopedics.about.com/od/overuseinjuries/a/compartment.htm.

Cohen, S. (2008).Compartment syndrome a complication of trauma with potential limb threatening outcome. Retrieved November 12, 2008 from http://muscle-injuries.suite101.com/article.cfm/compartment_syndrome

Haddad, S.L. (2007).Compartment syndrome. Retrieved November 12,2008 from http://orthoinfo.aaos.org/topic.cfm?topic=a00204


Liz Morris, ATC

Liz Morris, ATC is a second year graduate student and recipient of the Hughston Athletic Training Fellowship Program in Columbus, Georgia. She received her Bachelors of Science Degree in Athletic Training from Georgia College and State University in May of 2007, where she also minored in Dance. While at GC&SU Liz worked with men’s and women’s tennis, as well as softball, and completed a high school rotation with Tattnall Square Academy and First Presbyterian Day School both in Macon. She was a member of the Kinesiology club and received the Presidential Volunteer Service Award. She is an active member of the National Athletic Trainers Association (NATA) and the Georgia Athletic Trainers Association (GATA). Liz is responsible for the overall healthcare of the athletes at Glenwood School in Phenix City, Alabama.

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