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Condition

Compartment Syndrome

Condition 101

What is the definition of Compartment Syndrome?

Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.

What are the alternative names for Compartment Syndrome?

Fracture - compartment syndrome; Surgery - compartment syndrome; Trauma - compartment syndrome; Muscle bruise - compartment syndrome; Fasciotomy - compartment syndrome

What are the causes for Compartment Syndrome?

Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, similar to the way in which insulation covers wires.

Fascia do not expand. Any swelling in a compartment will lead to increased pressure in that area. This raised pressure, presses the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the arm or leg will no longer work. Surgery or even amputation may be done to correct the problem.

Acute compartment syndrome may be caused by:

  • Trauma, such as a crush injury or surgery
  • Broken bone
  • Very bruised muscle
  • Severe sprain
  • A cast or bandage that is too tight
  • Loss of blood supply due to the use of a tourniquet or positioning during surgery

Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running. The pressure in a compartment only increases during that activity and goes down after the activity is stopped. This condition is usually less limiting and does not lead to loss of function or limb. However, the pain can limit activity and endurance.

Compartment syndrome is most common in the lower leg and forearm. It can also occur in the hand, foot, thigh, buttocks, and upper arm.

What are the symptoms for Compartment Syndrome?

Symptoms of compartment syndrome are not easy to detect. With an acute injury, the symptoms can become severe within a few hours.

Symptoms may include:

  • Decreased sensation, numbness, tingling, weakness of the affected area
  • Paleness of skin
  • Severe pain that doesn't go away after taking pain medicine or raising the affected area
  • Swelling or inability to move the affected part

What are the current treatments for Compartment Syndrome?

The aim of treatment is to prevent permanent damage. For acute compartment syndrome, surgery is needed right away. Delaying surgery can lead to permanent damage. The surgery is called fasciotomy and involves cutting the fascia and muscle to relieve pressure.

For chronic compartment syndrome:

  • If a cast or bandage is too tight, it should be cut or loosened to relieve the pressure
  • Stopping the repetitive activity or exercise, or changing the way it's done
  • Raising the affected area above heart level to decrease swelling

What is the outlook (prognosis) for Compartment Syndrome?

With prompt diagnosis and treatment, the outlook is excellent and the muscles and nerves inside the compartment will recover. However, the overall outlook is determined by the injury that led to the syndrome.

If the diagnosis is delayed, permanent nerve injury and loss of muscle function can result. This is more common when the injured person is unconscious or heavily sedated and cannot complain of pain. Permanent nerve injury can occur after 12 to 24 hours of compression.

What are the possible complications for Compartment Syndrome?

Complications include permanent injury to nerves and muscles that can dramatically impair function. This is called Volkmann ischemic contracture if it occurs in the forearm.

In more severe cases, amputation may be required.

When should I contact a medical professional for Compartment Syndrome?

Call your provider right away if you have had an injury and have severe swelling or pain that does not improve with pain medicines.

How do I prevent Compartment Syndrome?

There is probably no way to prevent this condition. Early diagnosis and treatment helps prevent many of the complications.

If you wear a cast, see your provider or go to the emergency room if pain under the cast increases, even after you have taken pain medicines and raised the area.

REFERENCES

Jobe MT. Compartment syndrome and Volkmann contracture. In: Azar FM, Beaty JH, Canale ST, eds. Campbell's Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 74.

Modrall JG. Compartment syndrome and its management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular and Endovascular Surgery. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 102.

Stevanovic MV, Sharpe F. Compartment syndrome and Volkmann ischemic contracture. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 51.

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Latest Research

Latest Advance
Study
  • Condition: Compartment Syndrome with Novel Coronavirus Pneumonia
  • Journal: Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery
  • Treatment Used: Surgical Decompression
  • Number of Patients: 1
  • Published —
This case report describes a 49-year-old male with compartment syndrome treated with surgical decompression who developed novel coronavirus pneumonia which was treated with anti-infection, anti-virus, expectorant, heat-clearing and detoxifying drugs, bedside dialysis, and nutrition support.
Latest Advance
Study
  • Condition: Compartment Syndrome after Distal Biceps Brachii Tendon Rupture in an Athlete
  • Journal: Einstein (Sao Paulo, Brazil)
  • Treatment Used: Surgery
  • Number of Patients: 1
  • Published —
This case report discusses an athlete who did not use oral anticoagulant, who suffered a rupture of the distal biceps brachii tendon, and evolved into arm compartment syndrome treated with emergency fasciotomy and tendon repair.
Latest Advance
Study
  • Condition: Chronic exertional compartment syndrome
  • Journal: Journal of orthopaedic surgery (Hong Kong)
  • Treatment Used: Minimally invasive fasciotomy using a lighted retractor
  • Number of Patients: 0
  • Published —
The study researched the use of minimally invasive fasciotomy using a lighted retractor for patients with chronic exertional compartment syndrome.
Latest Advance
Study
  • Condition: Severe burns
  • Journal: Burns : journal of the International Society for Burn Injuries
  • Treatment Used: Biological Engineering Technology formula
  • Number of Patients: 40
  • Published —
The study researched the outcomes of resuscitation with albumin using Biological Engineering Technology formula for severely burned patients.

Clinical Trials

Clinical Trial
Procedure
  • Status: Recruiting
  • Study Type: Procedure
  • Participants: 100
  • Start Date: June 1, 2020
Renal- and Pulmonary Function in Relation to Abdominal Hypertension After Abdominal Reconstruction: The REPARE-study
Clinical Trial
Diagnostic Test
  • Status: Recruiting
  • Study Type: Diagnostic Test
  • Participants: 360
  • Start Date: December 26, 2019
Predictive Ability of Intra-Abdominal Pressure for Mortality in Patients With Severe Acute Pancreatitis: A Prospective Observational Study
Clinical Trial
Biological
  • Status: Recruiting
  • Study Type: Biological
  • Participants: 18
  • Start Date: December 4, 2019
Autologous Bone Marrow Mononuclear Cell Administration for Lower Extremity Compartment Syndrome Injury
Clinical Trial
Drug
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 200
  • Start Date: November 18, 2019
Neuromuscular Blockade in the Intentive Care Unit, an Observational Study.