Learn About Compartment Syndrome

What is the definition of Compartment Syndrome?

Acute 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.

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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 of 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 of 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:

  • Pain that is much higher than expected with the injury
  • Severe pain that doesn't go away after taking pain medicine or raising the affected area
  • Decreased sensation, numbness, tingling, weakness of the affected area
  • Paleness of skin
  • Swelling or inability to move the affected part
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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 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
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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 less than 12 to 24 hours of compression. Muscle injuries can occur even faster.

What are the possible complications of 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. At times, fasciotomies are performed earlier to avoid compartment syndrome from occurring in the case of severe trauma.

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.

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What are the latest Compartment Syndrome Clinical Trials?
COmpartment Syndrome vaLidation Of Non Invasive Assessment of Tissue Pressure (COLONIA)

Summary: Chronic Compartment Syndrome (CCS) is a pathology that affects more specifically subjects exposed to repeated movements, particularly in a professional life or sports. The diagnosis is difficult and often delayed. Currently, the reference technique is invasive. It consists of measuring by a intramuscular puncture (IMP) pressure in the offending compartment early after effort (usually between 1 and...

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Phase II The Use of Near Infrared Spectroscopy in the Diagnosis of Acute Compartment Syndrome in Trauma Patients

Summary: This is a study intended to evaluate a new device that uses light to measure the amount of oxygen in the muscles of injured and non-injured legs and forearms in specific situations. The name of this technology is NIRS (near-infrared spectroscopy). This is a prospective observational cohort study intended to gather data using NIRS among injured and noninjured extremities over time. Additionally, th...

What are the Latest Advances for Compartment Syndrome?
Does An Osteotomy Performed in Congenital Pseudarthrosis of the Tibia Heal?
Acute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrared Thermography in the Assessment of Tissue Perfusion.
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Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis.
Who are the sources who wrote this article ?

Published Date: July 25, 2020
Published By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

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.