Acute Compartment Syndrome The classic sign of acute compartment syndrome is pain, especially when the muscle within

the compartment is stretched. The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain. There may also be tingling or burning sensations (paresthesias) in the skin. The muscle may feel tight or full. Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury. Chronic (Exertional) Compartment Syndrome Chronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg. Symptoms may also include: Numbness Difficulty moving the foot Visible muscle bulging Top of page Doctor Examination Acute Compartment Syndrome Go to an emergency room immediately if there is concern about acute compartment syndrome. This is a medical emergency. Your doctor will measure the compartment pressure to determine whether you have acute compartment syndrome. Chronic (Exertional) Compartment Syndrome To diagnose chronic compartment syndrome, your doctor must rule out other conditions that could also cause pain in the lower leg. For example, your doctor may press on your tendons to make sure you do not have tendonitis. He or she may order an X-ray to make sure your shinbone (tibia) does not have a stress fracture. To confirm chronic compartment syndrome, your doctor will measure the pressures in your compartment before and after exercise. If pressures remain high after exercise, you have chronic compartment syndrome. Top of page Treatment Acute Compartment Syndrome Acute compartment syndrome is a surgical emergency. There is no effective nonsurgical treatment. Your doctor will make an incision and cut open the skin and fascia covering the affected compartment. This procedure is called a fasciotomy. Sometimes, the swelling can be severe enough that the skin incision cannot be closed immediately. The incision is surgically repaired when swelling subsides. Sometimes a skin graft is used.

Chronic (Exertional) Compartment Syndrome Nonsurgical treatment. Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms. Your symptoms may subside if you avoid the activity that caused the condition. Crosstraining with low-impact activities may be an option. Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artficial turf vs. grass). Symptoms may be relieved by switching surfaces. Surgical treatment. If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell. Usually, the skin incision for chronic compartment syndrome is shorter than the incision for acute compartment syndrome. Also, this surgery is typically an elective procedure -- not an emergency. Top of page

What are the complications of compartment syndrome?

Left unrecognized or untreated, the complications of acute compartment syndrome are irreversible. As swelling increases and muscle loses its blood supply, cells eventually die and muscle necrosis occurs. Complications include: muscle scarring, contracture and loss of function of the limb; infection; amputation; permanent nerve damage; and/or rhabdomyolysis and kidney damage. Complications due to chronic or exercise induced compartment syndrome are rare but may include any of the above, especially if the person requires surgery to alleviate the chronic condition.

What is the prognosis for compartment syndrome?

Acute compartment syndrome is a potentially devastating condition. Return of normal function and minimizing injury depends upon quick recognition of the situation and prompt surgical fasciotomy to resolve the increased pressure. The longer the delay to surgery, the more potential for permanent loss of muscle and nerve function. The prognosis for chronic compartment syndrome is usually excellent.

Compartment Syndrome At A Glance

Compartment syndrome describes increased pressure within a muscle compartment of the arm, leg or other extremity, most often due to injury, that causes muscle and nerve damage due to decreased blood supply. Symptoms include excessive amounts pain, numbness, and decrease range of motion. Surgery (fasciotomy) is the only treatment for acute compartment syndrome. The muscle compartment is cut open to allow muscle tissue to swell, decrease pressure and restore blood flow.

 Complications may include muscle loss, amputation, infection, nerve damage, and kidney failure. Prevention efforts include ice and elevation of the affected extremity. Chronic compartment syndrome usually requires no treatment or sWhat is the treatment for compartment syndrome? Prevention is the first step in the treatment of compartment syndrome. Significant injuries of the arms and legs that require casting or splinting should always be elevated and iced to minimize the potential for swelling. Elevation should be above the level of the heart. Ice therapy may even be considered even if a cast or splint has been placed. Chronic or exercise induced compartment syndrome rarely requires any treatment; the pain and other symptoms usually stop minutes to hours after the activity is stopped. However, some individuals, over time, find the chronic compartment syndrome to be very limiting, especially if it causes them to stop a favorite sport (for example, running, tennis, or football). Rarely, such individuals may have a surgeon cut open some of the fascia that comprises the compartment to reduce or stop the symptoms.

Surgery (fasciotomy)
The treatment for acute compartment syndrome is surgery (fasciotomy). The surgeon (either an orthopedic or general surgeon) will perform a fasciotomy (see last reference for video of procedure), an operation where the thick, fibrous bands that line the muscles are filleted open, allowing the muscles to swell and relieve the pressure within the compartment (similar to splitting open the casing of a sausage). Depending upon the amount of swelling (edema), a second operation may be required later to close the skin after the swelling has resolved. Once acute compartment syndrome has occurred, there is no non-surgical alternative. Hyperbaric oxygen may be considered as an adjunct treatment after surgery to promote healing. Treatment will also be directed to the underlying cause of the compartment syndrome and to try to prevent other associated complications including kidney failure due to rhabdomyolysis. urgery.