Compartment Syndrome

Compartment Syndrome: Overview

Alternative Names: Chronic Compartment Syndrome (CCS), Chronic Exertional Compartment Syndrome (CECS), Exertional Compartment Syndrome, Acute Compartment Syndrome.

Compartment syndrome is a painful muscle and nerve condition of the arms or legs.  The main symptoms are pain that increases when the muscle is stretched and subsides with rest; swelling; and sometimes loss of muscle function.

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It is important to distinguish between the chronic and acute forms of compartment syndrome.  Chronic compartment syndrome is generally exercise-induced, caused by overexertion.  Acute compartment syndrome, on the other hand, is a medical emergency, usually caused by severe injury.  Without treatment, it can lead to permanent muscle damage.

Incidence; Causes and Development; Contributing Risk Factors

Anyone can be affected, but it is most common in athletes who perform repetitive impact exercise such as running and fast walking.  Males and females are equally affected.

The muscles, nerves and blood vessels in our arms and legs are isolated into segments (or "compartments") by bands of tough connective tissue (fascia) that hold them together in bundles.  Excessive pressure within one of these compartments causes compartment syndrome.

Exercise increases the blood supply to working muscles, causing expansion.  If the containing fascia doesn't also expand, pressure builds up in the compartment; prolonged pressure within the compartment cuts off some of the blood supply and prevents nourishment and oxygen from reaching nerve and muscle cells, leading to chronic exertional compartment syndrome.

Exactly why this happens is not clear.  Some doctors believe that how you move may play a role; other causes may include enlarged muscles, an especially inelastic fascia, or high blood pressure within your veins.  Other causes include anabolic steroid use and bandages that are too tight.

Acute compartment syndrome is generally caused by trauma, leading to bleeding within a compartment.  Causes of bleeding may include a car or sports accident (fractures, severe muscle bruising, crush injuries), a broken bone, or surgery.

Increased risk is associated with age (being under 30), repetitive impact-type exercise, overtraining, and drugs such as anabolic steroids or supplemental creatine which may increase water content and mass of muscles.  Chronic exertional compartment syndrome is usually observed in competitive or college athletes.

Signs and Symptoms

Compartment syndrome usually occurs in the lower leg and includes one or more of the following symptoms:

  • Aching, burning or cramping pain, increasing when the muscle is used.  Pain typically begins soon after starting exercise and progressively worsens, ending within 30 minutes of stopping exercise.  As the condition worsens, the pain may linger for up to 24-48 hours.
  • Muscle tightness
  • A sense of 'fullness' in the affected compartment
  • Tingling
  • Weakness and loss of control
  • Difficulty moving a foot
  • Foot drop, in severe cases, if nerves of the legs are affected
  • (Less common) Visible swelling or bulging caused by a muscle hernia
  • Numbness or paralysis (late signs, often indicating permanent tissue injury.)

Chronic compartment syndrome most often occurs in the front compartment of the lower leg.  It occurs less frequently in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.  One United States study found a 14% prevalence rate of anterior CECS in individuals who reported lower leg pain.

Diagnosis and Tests

Diagnosis involves ruling out other conditions such as tendonitis that might cause pain in the affected muscle.  An X-ray may also be used to see if there is a stress fracture.

Diagnosis involves measuring the compartment pressure to determine whether acute compartment syndrome is present.

Treatment and Prevention

For chronic (exertional) compartment syndrome, reducing or stopping exercise should relieve symptoms at least temporarily, but symptoms generally return upon resuming previous exercise levels.

For acute compartment syndrome the pressure needs to be relieved quickly via surgery, or permanent disability and tissue death may result.

Prognosis; Complications; Seek medical attention if...

Chronic exertional compartment syndrome isn't life-threatening usually doesn't cause permanent damage if treated properly.  However, continuing to exercise or failing to treat it can cause lasting damage.

Complications due to surgery have been reported in 11-13% of cases and include hemorrhage, wound breakdown, complications from anesthesia, and postoperative infection.

Go to an emergency room immediately if there is concern about acute compartment syndrome.

Any unusual pain, swelling, weakness, loss of sensation, or soreness should be investigated by a doctor because these symptoms may be associated urgent medical conditions.  Continuing to exercise through the pain may lead to permanent muscle or nerve damage.

On This Page

Compartment Syndrome:

Signs, symptoms & indicators of Compartment Syndrome:

Symptoms - Skeletal

(Severe) non-specific arm pain

Compartment syndrome usually occurs in the legs, but very occasionally affects the arms.

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Recommendations for Compartment Syndrome:

Drug

NSAIDs

NSAIDs may be effective, but are generally believed to have questionable usefulness.

Physical Medicine

Rest

Symptoms should subside if the activity that caused the problem is avoided, either by resting or by performing other forms of exercise.

Physical Supports and Devices

Orthotics (inserts for shoes) are generally not very useful.

Physical Therapy

Physical therapy is suggested by some, but has questionable effectiveness.

Surgery/Invasive

Surgery

Acute compartment syndrome is a surgical emergency requiring a fasciotomy: opening the skin and fascia covering the affected compartment, allowing room for the muscle to swell.  There is no effective non-surgical treatment.

In cases of chronic (exertional) compartment syndrome, if conservative treatment doesn't help, surgical intervention generally has a good success rate, with success being defined as the return to athletics without significant symptoms.  In the anterior (front) compartment of the leg, the success rate is over 85%; in the deep posterior (rear) compartment, the success rate is only around 70%.

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