Compartment Syndrome

Compartment syndrome is a painful condition that results when pressure within the muscles builds to dangerous levels, preventing nourishment from reaching nerve and muscle cells. In the arms, legs, feet and buttocks, muscle groupswith the nerves and blood vessels that flow beside and through themare covered by a tough membrane (fascia) that does not readily expand. The resulting unit is called a compartment. If pressure within the compartment is excessive, it can cause damage to blood vessels and nerve and muscle cells.

Compartment syndrome can be either acute or chronic. Acute compartment syndrome can have disastrous consequences, including paralysis, loss of limb or loss of life. Chronic compartment syndrome is not a medical emergency, but can be a significant problem for an athlete. Acute compartment syndrome A traumatic injury, such as a fracture of one of the long bones in the body, can often trigger acute compartment syndrome. If the injured limb continues to swell after a rigid cast is applied, compartment syndrome may result. In that case, the cast will have to be split or removed to alleviate the problem

Other conditions that can bring on acute compartment syndrome include:
• A badly bruised muscle, as when a motorcycle falls on the leg of the rider or a football player receives a blow to the thigh from another players helmet
• A complication after surgery
• A crush injury to the foot
• A result of anabolic steroid use
• A major change in activity level, such as with long distance runners or new military recruits It may take several hours for acute compartment syndrome to develop. Within the muscle compartment, swelling and/or bleeding creates pressure on capillaries and nerves. When the pressure in the compartment exceeds the blood pressure within the capillaries, the capillaries collapse, disrupting the blood flow to muscle and nerve cells. Without a steady supply of oxygen and nutrients, nerve and muscle cells begin to die in a matter of hours. Unless the pressure is relieved quickly, permanent disability and even death may result.

Signs and Symptons:
A syndrome is a combination of signs and symptoms that characterize an abnormal condition. The classic sign of acute compartment syndrome is pain, especially when the muscle is stretched.
• The pain may be intensely out of proportion to the injury, especially if no bone is broken.
• There may also be a tingling or burning sensation (paresthesias) in the muscle.
• The muscle may feel tight or full.
• If the area becomes numb or paralysis sets in, cell death has begun and efforts to lower the pressure in the compartment may not be successful in restoring function. Diagnosis and treatment of acute compartment syndrome Your physician has instruments that measure the compartment pressure. This pressure is subtracted from the diastolic blood pressure (the bottom number in a blood pressure reading). The result is used to determine the presence of compartment syndrome and the possible need for surgery. If surgery is required to relieve the pressure, the physician will make an incision and cut open the fascia covering the affected compartment. This allows excess fluids to drain, reducing the pressure in the compartment. The incision is closed when swelling recedes, although sometimes a skin graft may be needed.

Chronic Compartment Syndrome
Chronic or exertional compartment syndrome is a characterized by exercise-induced pain and swelling that is relieved by rest. It usually occurs in the lower leg and is occasionally accompanied by numbness or difficulty in bending the foot down. Symptoms dissipate quickly when activity stops, but compartment pressures may remain elevated for some time afterwards. Diagnosis and treatment of chronic compartment syndrome Chronic compartment syndrome must be differentiated from other pains in the lower leg, such as stress fractures of the shinbone (tibia) and tendinitis. To diagnose chronic compartment syndrome, the physician measures the intramuscular pressure before exercise, one minute after exercise, and five minutes after exercise. If pressures remain high, chronic compartment syndrome is present. Conservative treatment is usually effective:
• Refrain from the offending activity, apply ice and elevate the limb slightly.
• Do not wrap the leg because this will increase the pressure and aggravate the condition.
• Take aspirin or ibuprofen to reduce inflammation.
• Cross-training with low-impact activities may be permitted as long as symptoms do not return.
• Surgical release may be needed if conservative treatment is ineffective.