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Acute Compartment Syndrome

Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.

Conditions that may bring on acute compartment syndrome include:

• A fracture.
• A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg by another player's helmet. It can also happen after overly vigorous exercise that causes muscle tissue to break down (rhabdomyolysis)
• Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people whose brain function is impaired. This can happen after severe intoxication with alcohol or other drugs.
• Crush injuries.
• Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.
• Constricting bandages. Casts and tight bandages may lead to compartment syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.

Chronic (Exertional) Compartment Syndrome

The pain and swelling of chronic compartment syndrome is caused by exercise. People who participate in activities with repetitive motions, such as running or marching, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.

Acute Compartment Syndrome

The classic sign of acute compartment syndrome is severe 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 (paresthesia) in the skin.
• The muscle may feel tight or full.
• Numbness or paralysis are late signs of compartment syndrome. This usually indicates permanent tissue injury.

Chronic (Exertional) Compartment Syndrome

Chronic compartment syndrome causes pain or cramping during exercise. This pain goes away when activity stops. It most often occurs in the leg.

Symptoms may also include:

• Numbness
• Difficulty moving the foot, sometimes with a sense of the foot slapping downward when running
• Visible muscle bulging

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 examine you to determine whether you have acute compartment syndrome. They may also measure the compartment pressure in your affected limb.

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 tendinitis. They 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.

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 is severe enough that the skin incision cannot be closed immediately. The incision is repaired later 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 may be of limited benefit in relieving symptoms and generally do not allow return to full activity.

• Your symptoms may subside if you avoid the activity that caused the condition.
• Cross-training with low-impact activities may be an option.
• Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artificial turf vs. grass). Symptoms may be relieved by switching surfaces.
• Changing from heel strike to toe running may modify symptoms depending on the compartments involved.

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 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.

Surgery for chronic exertional compartment syndrome of the leg produces excellent results in the anterior and lateral compartments, and less predictable results when the posterior compartments are involved. An accurate diagnosis is key to achieving a significant benefit from surgery.

To assist doctors in the management of acute compartment syndrome, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Acute Compartment Syndrome - Clinical Practice Guideline | American Academy of Orthopaedic Surgeons (aaos.org)