Compartment syndrome is caused by compression of nerves, blood vessels and muscles in a closed space (compartment) in a certain body part, often the lower leg. This compression leads to tissue death due to lack of oxygenation as the blood vessels are being compressed by the raised pressure within the compartment.
Five “Ps” are associated with compartment syndrome — pain out of proportion to what is expected, paresthesia(altered sensation / pins & needles), pallor, paralysis and pulselessness.
⦁ Pain is described as severe, deep, constant and poorly localized pain, sometimes described as out of proportion with the injury. The pain is aggravated by stretching the muscle group within the compartment and is not even relieved by strong pain medication.
⦁ Paresthesia (altered sensation e.g. “pins & needles”) is a late symptom.
⦁ Paralysis of the limb is usually a late finding. The compartment may also feel very tense and firm (pressure) to touch. Some find that their feet and even legs fall asleep. This is because compartment syndrome prevents adequate blood flow to the rest of the leg.
⦁ Note that a lack of pulse rarely occurs.
⦁ Tense and swollen shiny skin, sometimes with obvious bruising of the skin.
⦁ Congestion of the digits(toes or fingers) with prolonged capillary refill time – the whiteness caused by pushing on the nails of the fingers or toes, takes a long time to return to a normal pink colour.
The connective tissue surrounding a muscle group(compartment) does not stretch – therefore a small amount of bleeding in a specific compartment, or swelling of the muscles within the compartment, can cause the pressure to rise greatly giving rise to compartment syndrome. Common causes include bone fractures, blood vessel damage, intravenous drug injection, ill-fitting casts, prolonged compression, crush injuries and burns. Repetitive use or muscle overuse can also lead to this condition and often occur in cyclists and long distance runners – in these instances this is termed chronic compartment syndrome. A history of creatine use has been linked to this condition as well.
Acute compartment syndrome is a medical emergency requiring immediate surgical treatment, known as a fasciotomy, where a cut is made throught the connective tissue surrounding the involved muscle group, to allow the pressure to return to normal.
Chronic compartment syndrome can be treated conservatively or surgically in persistent cases. Conservative treatment includes rest, anti-inflammatories, elevation of the limb and manual decompression by means of physiotherapy. Left untreated, chronic compartment syndrome can develop into the acute syndrome.