Your Orthopaedic Connection: Compartment Syndrome

Compartment Syndrome

Compartment syndrome is a painful condition that results when pressure within the muscles builds to dangerous levels. This prevents nourishment from reaching nerve and muscle cells.

Muscle groups in the arms, hands, legs, feet, and buttocks can be affected. Within these muscle groups are nerves and blood vessels. The muscle groups are covered by tough membrane (fascia), which does not readily expand. The whole unit is called a compartment.

If pressure within the compartment gets too high (for example, from too much swelling or bleeding after surgery or injury), the lack of oxygen to the tissue can damage blood vessels and nerve and muscle cells.

(Reproduced with permission from Gruel CR: Lower Leg, in Sullivan JA, Anderson SJ (eds): Care of the Young Athlete. Rosemont, IL, American Academy of Orthopaedic Surgeon, 2000.)

Compartment syndrome can be either acute or chronic. Acute compartment syndrome is a medical emergency. Without treatment, it can lead to paralysis, loss of limb or death. Chronic compartment syndrome is not a medical emergency.

Cause

Acute Compartment Syndrome

It may take several hours for acute compartment syndrome to develop. Within the muscle compartment, swelling and/or bleeding creates pressure on capillaries and nerves. When the pressure in the compartment exceeds the blood pressure within the capillaries, the capillaries collapse. This disrupts the blood flow to muscle and nerve cells. Without a steady supply of oxygen and nutrients, nerve and muscle cells begin to die within hours. Unless the pressure is relieved quickly, this can cause permanent disability or death.

A traumatic injury, such as a fracture of one of the long bones in the body, can often trigger acute compartment syndrome. If the injured limb continues to swell after a rigid cast or tight dressing is applied, a compartment syndrome may result. In that case, the cast or dressing will have to be split or removed as the first step to help alleviate the problem. Other conditions that can bring on acute compartment syndrome include:

A severely bruised muscle, as when a motorcycle falls on the leg of the rider or a football player receives a strong blow to the thigh from another player's helmet
A complication after surgery
Blockage of circulation, such as from pressure over a blood vessel for too long while asleep
A crush injury

Chronic Compartment Syndrome

Chronic compartment syndrome is characterized by pain and swelling caused by exercise. It can be a significant problem for an athlete. It gets better when you rest. It usually occurs in the leg. It is occasionally accompanied by numbness or difficulty in moving the foot. Symptoms dissipate quickly when activity stops. Compartment pressures may remain elevated for some time afterwards.

Top of page

Symptoms

A combination of signs and symptoms characterize compartment syndrome. The classic sign of acute compartment syndrome is pain, especially when the muscle is stretched.

The pain may be intensely out of proportion to the injury, especially if no bone is broken.
There may also be a tingling or burning sensation (paresthesias) in the muscle.
The muscle may feel tight or full.
If the area becomes numb or paralysis sets in, cell death has begun and efforts to lower the pressure in the compartment may not be successful in restoring function.

Top of page

Diagnosis

To diagnose chronic compartment syndrome, the doctor must rule out other conditions that could also cause pain in the lower leg. These may include stress fractures of the shinbone (tibia) and tendonitis. To diagnose chronic compartment syndrome, the physician measures the intramuscular pressure before exercise, one minute after exercise, and five minutes after exercise. If pressures remain high, you have chronic compartment syndrome.

Top of page

Treatment

Nonsurgical Treatment

See your doctor right away if there is concern about the development of chronic compartment syndrome. He or she has instruments that measure the compartment pressure. The doctor uses the result to determine if you have compartment syndrome and whether you need surgery.

Nonsurgical treatment is usually not effective for this condition. Nonsurgical management may include:

Avoiding doing activities that cause pain and swelling
Applying ice and elevating the limb slightly
Taking aspirin or ibuprofen to reduce inflammation
Increased cushioning in shoes

Do not wrap the leg because this will increase the pressure and aggravate the condition. Ask your doctor if cross-training with low-impact activities is acceptable as long as symptoms do not return. Surgical release may be needed if conservative treatment is ineffective.

Surgical Treatment

If surgery is required to relieve the pressure, the physician will make an incision and cut open the skin and fascia covering the affected compartment. This reduces the pressure in the compartment. The skin incision is surgically repaired when swelling recedes. Sometimes a skin graft may be needed.

Top of page

Last reviewed and updated: July 2007

AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.