Compartment Syndrome

Compartment syndrome occurs when blood supply is dramatically reduced to muscles in a closed body space, known as a compartment. Compartments are found in the hand, forearm, upper arm, abdomen, buttock, and leg. The muscles most frequently involved are those on the front of the lower leg or the palm side of the forearm.

What is going on in the body?

A muscle group is surrounded by a tough, fibrous membrane called the fascia. Small blood vessels supply the muscle with oxygen and other essential nutrients. Insufficient blood supply to tissues and compartment syndrome can occur if:

the muscle compartment size is reduced, as when a cast is too tight

the muscle compartment contents are increased, such as by swelling or bleeding associated with injury

If the affected muscles are deprived of blood supply for more than 6 hours, nerve and muscle tissue can be permanently damaged or destroyed.

What are the causes and risks of the condition?

Some common causes of compartment syndrome include:

bleeding, from a bone fracture or other injuries

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casts applied to treat bone fractures or other abnormalities

a crush injury

intense exercise

leaking of intravenous fluid or injections into the compartment

repeated use of a muscle group

seizures that involve the muscles in the compartment

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swelling of the muscle itself

What are the signs and symptoms of the condition?

The person will usually complain of increasingly severe, constant pain in the affected muscles. Often the degree of pain seems more than expected for the severity of the injury. Other symptoms of compartment syndrome include:

decreased pulses below the affected area

difficulty making the muscle move

intense pain with stretching of the muscle

numbness in the skin

pale skin

swelling and tenderness of the muscle

Intermittent compartment syndrome can occur. A runner with this condition may complain of tightness and aching in the calf muscles. The person may run a relatively short distance and need to stop due to discomfort. The tightness gradually goes away after the person stops running.

How is the condition diagnosed?

Diagnosis of compartment syndrome begins with a medical history and physical exam. The raised pressure within the compartment can be measured with specialized instruments.

What can be done to prevent the condition?

Acute compartment syndrome can sometimes be avoided by early stabilization of a fracture. This may involve splinting, elevating the injured limb on a pillow, and applying ice to reduce swelling. If a person has a cast, circulation to the area below the cast will be checked frequently. If circulation is impaired or the person has severe pain, the healthcare provider may choose to cut the cast to relieve pressure.

What are the long-term effects of the condition?

If compartment syndrome is untreated, death of the muscles can occur. Muscles can become inactive and excessively tight. Toes or fingers may become fixed in a curled position with permanent numbness. Severe tissue death may lead to the need for amputation of the affected limb.

What are the risks to others?

Compartment syndrome is not contagious and poses no risk to others.

What are the treatments for the condition?

Diagnosis must be made accurately and promptly to assure a good outcome. Initial treatment consists of elevating the limb above the level of the heart. If a cast has been applied, it is removed. A surgical procedure known as a fasciotomy may be used to open the membrane leading to the affected muscles. Pressure is relieved, and the blood flow can return to normal. Often the skin needs to be left open for a few days. It can be closed with sutures or a skin graft after the swelling goes down.

What are the side effects of the treatments?

Surgery can cause bleeding, infection, or allergic reaction to anesthesia. The muscle and nerves may not return to normal after recovery.

What happens after treatment for the condition?

A scar may appear where the skin was left open following surgery.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.