Compartment syndrome is a painful condition that is the result of a buildup of pressure around a muscle within a muscle compartment. This pressure can decrease blood flow and prevent nourishment and oxygen from reaching nerve and muscle cells, which can lead to tissue death and permanent damage. The best help you can get with compartment syndrome is from the experienced orthopedic specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado. Rapid diagnosis and prompt, accurate treatment leads to the best outcomes.

OVERVIEW

Compartment syndrome, also called exertional compartment syndrome (CESE), can happen to any muscle group, but 95% of cases are in the lower leg. It can be either acute (having severe symptoms for a short period) or chronic (long-lasting), depending on the injury that caused it. The median age of onset is under age 30 in male and female athletes. It is most commonly due to physical trauma such as a bone fracture (up to 75% of cases), but it can also be caused by acute exertion during sport.

WHAT IS A MUSCLE COMPARTMENT?

Compartments are groupings of muscles, nerves, and blood vessels in the legs. The lower leg, for example, has four compartments. Webs of connective tissue called facia surround these structures, similar to how insulation covers wires. The role of the fascia is to keep the tissues in place, and, therefore, unlike muscles, the fascia does not stretch or expand easily to make room for swelling, blood, or fluid resulting from inflammation or injury. As pressure keeps building in the compartment, the fascia eventually runs out of room and starts squeezing against the muscles and nerves.

ABOUT COMPARTMENT SYNDROME

There are two types of compartment syndrome: chronic and acute. Both conditions involve increased pressure within a muscle compartment, but they differ in their onset, symptoms, and management.

• Chronic: Chronic compartment syndrome, also known as exertional compartment syndrome, tends to develop gradually over time, usually in individuals who engage in repetitive or prolonged physical activities. The increased pressure within the muscle compartment occurs during exercise when the muscle swells, but the pressure usually subsides with rest. Chronic exertional compartment syndrome often occurs in the same compartment of an affected limb on both sides of the body, usually the lower leg.
• Acute: Acute compartment syndrome is the most common and more serious type of compartment syndrome.  Seventy-five percent of cases of acute compartment syndrome are associated with fractures, with tibial fractures being the most common cause of the condition, followed by distal radius fractures. Acute compartment syndrome develops rapidly over hours or days and requires immediate medical attention.

CAUSES

What causes compartment syndrome depends on which type it is.

Chronic causes:

• Repetitive impact activities such as running, biking, or weightlifting
• Overtraining—working out too intensely or too frequently
• Doing a repetitive motion at work or for a hobby

Acute causes:

• Fractures
• Sports injuries
• Crush injuries such as those sustained in a car accident or industrial accident
• Prolonged pressure from wearing a cast or tight bandage
• Post-surgery complications
• Burns
• Vascular injuries

SYMPTOMS

Known as “the 5 Ps”, these are the classic signs and symptoms traditionally associated with compartment syndrome:

• Pain—persistent and disproportionate
• Paresthesia—numbness, tingling, or altered sensation
• Pallor—paleness of skin
• Paralysis—weakness or inability to move the affected limb
• Pulselessness—diminished or absent peripheral pulses in the affected limb

Some sources add a sixth “P” to the list to emphasize the severity and urgency of the condition:

• Poikilothermia: This refers to the affected limb being cold to the touch and taking on the temperature of the surrounding environment

NON-SURGICAL TREATMENTS

Most non-surgical treatments aim to prevent permanent damage. Some treatments include:

• Anti-inflammatory medications like NSAIDS or acetaminophen
• Changing one’s exercise routine to lower-impact exercise
• Resting
• Icing
• Elevation
• Physical therapy
• Orthotics

WHEN IS SURGERY INDICATED?

When more conservative methods don’t work, surgery may be required. The surgeon may perform an operation called a fasciotomy. They’ll make an incision through the skin and fascia to relieve pressure in the affected muscle. In severe cases, the doctor will have to wait for the swelling to go down before closing the incision, and some of these wounds require skin grafting.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.  

With extreme skill and painstaking attention to detail, the unrivaled surgeons at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, are recognized for their exceptional outcomes in both chronic and acute chronic syndrome. Part of their thorough exam will be to rule out other issues like tendinitis or shin splints, that can cause similar symptoms. X-rays may be ordered to help determine fractures or any other injuries. To confirm the diagnosis your surgeon may need to measure the pressure in the muscle compartment. This is done using a needle placed into the affected body area. The needle is attached to a pressure meter. The test is done during and after an activity that causes pain. At Advanced Orthopedics they are considerate of all you’re going through, and their primary goal is to get you going back to all the things you enjoy doing, pain-free. Schedule an appointment today.