Compartment syndrome

Content

Introduction

Compartment syndrome is a disease that occurs in the muscles of a limited area of ​​the body (fascial compartment) in which the tissue expansion space is reduced.

The syndrome occurs when a group of muscles (usually those in the hands, feet, arms and legs), surrounded by blood vessels and nerves, undergoes an increase in pressure due to a traumatic event (fractures and bruises) that causes edema and swelling of the soft tissue.

There are two types of compartment syndrome:

  • acute, comes on suddenly, usually following a fracture or other serious injury; it requires urgent medical intervention, so much so that it can cause permanent damage to the muscle if action is not taken quickly
  • chronic, it appears gradually, during or immediately after regular physical activity based on repeated effort (running, cycling). Usually it returns if the activity is interrupted; it does not require urgent medical intervention as there is no risk of permanent injury

Symptoms

Acute compartment syndrome

Disorders usually appear following a muscle breakdown and tend to worsen rapidly:

  • intense and disproportionate pain to the visible lesion, especially if you try to stretch the muscle
  • soreness and stiffening
  • tingling and burning sensation
  • numbness and a sense of weakness, in severe cases, when permanent injuries may have occurred

Chronic compartment syndrome

Disorders tend to develop gradually while exercising, but get better when resting:

  • cramps, mostly in the legs
  • enlarged muscles for swelling and bulging
  • tingling sensation
  • cooling and paleness of the affected muscle area
  • difficulty moving the affected body part, in the most serious cases

Causes

Acute compartment syndrome

The causes of acute compartment syndrome are usually the following:

  • bone fracture or crush injury (most common causes)
  • dressing with a plaster or a bandage that is too tight, applied to a limb before swelling has subsided
  • burn, which may have resulted in a scar on the skin
  • hematoma or edema, formed as a result of surgery on a damaged blood vessel

Chronic compartment syndrome

In this case the causes remain unknown; the disorder can be caused, during physical activity, by a temporary swelling of the muscle that affects the blood perfusion of an entire bundle of muscles.

Diagnosis

The assessment of compartment syndrome is carried out by measuring the compartment pressure with a special instrument which, under normal conditions, must be equal to or less than 20 millimeters of mercury.

Therapy

Acute compartment syndrome

In case of acute compartment syndrome, it is necessary to go to an emergency room within a few hours, to avoid permanent injury to the muscles or nerves; if it is a chronic compartment syndrome the situation is less serious, but it is still necessary to check the disorders and ascertain the causes (diagnosis).

Treatment is done in the hospital with an emergency surgical procedure known as fasciotomy, which provides for an incision on the skin in correspondence with the involved muscle groups, in order to immediately relieve the pressure of the entire set of muscles; the wound heals after a few days and only in some cases may a skin graft be necessary to cover the cut.

Chronic compartment syndrome

The therapeutic indications in this case include interrupting the type of activity that may have triggered the disorder and practicing a different, less demanding activity. Physiotherapy sessions, orthopedic insoles and analgesic, non-steroidal anti-inflammatory drugs are recommended. it is advisable to consult with your family doctor Surgery is only necessary if the complaints persist despite the therapy.

Bibliography

Guo J, Yin Y, Jin L, Zhang R, Hou Z, Zhang Y. Acute compartment syndrome: Cause, diagnosis, and new viewpoint. Medicine (Baltimore). 2019; 98: e16260

In-depth link

NHS. Compartment syndrome (English)

Mayo Clinic. Chronic exertional compartment syndrome (English)

Editor'S Choice 2022