Compartment syndrome is a serious medical condition that results from increased pressure within the compartment of the muscles. It is associated with pain and could ultimately lead to the tissue death (necrosis) if left untreated.
There are small compartments in muscles located in the legs, arms, and abdomen. These compartments are covered by a thick layer known as fascia, which prevents the muscles, blood vessels, and nerves from displacing from their location. Whenever there is damage to the compartment due to any bleeding or swelling, excessive pressure builds up in that area. This pressure restricts blood flow in the affected tissue, ultimately leading to permanent damage.
Compartment syndrome could be classified into two major types: acute compartment syndrome and chronic compartment syndrome.
Acute Compartment Syndrome is the most common form of compartment syndrome and is considered a medical emergency. The condition usually manifests after a few hours or some days after the injury. Regardless, immediate treatment is needed in order to prevent permanent damage of the affected tissue.
The following may causes Acute Compartment Syndrome:
- Severe injuries such as crush injuries
- Tight bandages which restrict the blood flow
- Long-term compression of the limb, in situations such as unconsciousness
- Surgery of the arms and legs involving blood vessels
- Long-term use of some medications such as anabolic steroids
Symptoms of Acute Compartment Syndrome
Abdominal Compartment Syndrome results from an injury to the abdomen, surgery, sepsis, ascites (accumulation of fluid), or vigorous abdominal exercises. This condition could damage the vital organs, such as the liver and kidneys, as it restricts blood flow in these organs.
A patient with ACS presents with one or multiple symptoms that usually appear immediately after the injury. Extreme pain is the earliest symptom of the condition. This pain is generally more acute than expected and worsens when the affected muscle is stretched. Typical symptoms of Abdominal Compartment Syndrome include abdominal bloating, abdominal distension, difficulty in breathing, a increased heart rate, less urine production, and low blood pressure. Other symptoms of ACS, such as the following, may also appear:
- Burning sensation in the skin
- Stretched or tight feeling in the affected area
- Paler skin color that is cold on the touch
- Paralysis and numbness in the affected tissue, which is usually a delayed symptom and depicts permanent damage
Chronic Compartment Syndrome (CCS)
Chronic Compartment Syndrome, also known as Exertional Compartment Syndrome, is a condition that results from the long-term use of the muscles. The lower extremities, such as the legs, buttock, and thigh, are mostly involved in CCS. This condition usually affects athletes and individuals above 30 years of age; however, in some cases, it also presents in younger individuals. Although Chronic Compartment Syndrome is not a medical emergency, a timely treatment is required to treat the condition in order to prevent any further damage to the affected tissue.
Below are some causes of Chronic Compartment Syndrome:
- High-intensity exercises performed by athletes, runners, or military personnel
- Enlarged muscles
- Non-elastic fascia surrounding the muscles or blood vessels
- Venous hypertension or increased pressure in the veins
Symptoms of Chronic Compartment Syndrome
In order to be diagnosed with Chronic Compartment Syndrome, the patient should have one or more of the following:
- Burning, aching, and cramping pain in the affected area, usually the lower limb
- Feeling of tightness and fullness in the affected area
- Tingling and numbness in the affected muscle
- Weaker affected limb
- Swelling or bulging in case of a muscle hernia
- Observable foot drop (in extreme cases)
Pain due to CCS follows a pattern. It usually starts at a specific time post-exercise and aggravates after the activity. The pain usually subsides 10 to 20 minutes after the exercise. It relieves further once the individual stops the activity; however, symptoms may reappear once it the activity is resumed.
Chronic Compartment Syndrome is often misinterpreted as shin splints, another major cause of leg pain in athletes; however, patients must seek professional advice when onset of CCS is suspected. Corrective action must be taken at the right time to avoid any further damage to the affected area.