Compartment syndrome occurs when excessive pressure develops in one of the body's compartments, exceeding the arterial pressure entering the compartment and so preventing blood from flowing in to supply the tissues. This can cause severe problems including great pain and tissue death if it is not treated quickly. This problem occurs mostly in the lower leg and in the forearm, where the muscles are all enclosed in a soft tissue section called a compartment, with the walls made up of bone and strong connective tissue called fascia. This makes the compartment inextensible and liable to pressure build up in certain circumstances.
Tibial fractures are the most common cause of compartment syndrome, other causes being compromise of the blood vessels, tight dressings or plasters, crush injuries and other fractures. Established compartment syndrome shows itself by a loss of sensation, loss of movement of the part and loss of pulses. Decompression of the tight compartment is the typical and most effective treatment for this syndrome. Complications include breakdown of muscle tissue which can progress to renal failure and Volkmann contracture, a non-reversible damage to the muscles of the forearm.
Whilst most compartment syndrome is acute following some kind of event, careful measurements of the pressures within the compartments of the leg have shown chronic compartment syndrome to be a clinical entity in situations such as excessive exercise performance. As the tissue pressure increases in the muscular and fascial compartment it starts to compromise the blood flow into the compartment, damaging the muscles and nerves. In the acute type the onset is fast and leads quickly to muscle and nerve damage which is irreversible unless treated urgently.
Shin splints in athletes have been regularly confused with chronic compartment syndrome, with the pain often on both sides and occurring after a particular period of exertion. The criteria for this condition vary in various pursuits and the abnormality can now be sought by pressure measurements. Open tibial fractures give the highest levels of compartment syndrome, with closed tibial fractures being much less risky for this condition. Vascular injuries may also precipitate compartment syndrome but vascular surgeons typically perform decompression at the time of repair if required.
For compartment syndrome to occur there must be either external or internal reasons for a raised pressure in the segments of the limb. External forces can include over tight clothes or boots and tight dressings or plasters. Internal factors can be numerous and include tissue swelling due to crush injury, fractures or internal tissue bleeding and even overdoing weightlifting. The muscles and the nerves are starved of blood due to the excessive pressure, causing chemical changes due to muscle necrosis which attract greater amounts of water into the compartment, increasing the pressure again. Eventually arterial blood flow is completely obstructed.
High compartment pressure need speedy surgical decompression as if it is left for six to ten hours the compartment will develop muscle death, nerve damage and more generalised tissue death. The damage to the muscles can allow the release of myoglobin into the circulation which can cause kidney damage which can be fatal. Chronic compartment syndrome is accompanied by an increase in the volume of muscles which increases the pressure, allowing this to remain raised between muscular contractions and interrupt blood flow. This develops into muscle cramps as the muscles are denied the required amounts of blood.
Compartment syndrome is normally managed by immediate surgical fasciotomy, with the muscle compartments being opened to permit pressure release and effect decompression. The surgeons may leave the wounds open for some time until the pressure eases and the local tissues settle.
Fasciotomy is the definitive surgical treatment for compartment syndrome, a cutting into the individual muscle compartments to allow the pressure to dissipate outwards and decompress the areas. The wounds may be left open for some days until the pressure subsides and the tissues recover. - 14130
Tibial fractures are the most common cause of compartment syndrome, other causes being compromise of the blood vessels, tight dressings or plasters, crush injuries and other fractures. Established compartment syndrome shows itself by a loss of sensation, loss of movement of the part and loss of pulses. Decompression of the tight compartment is the typical and most effective treatment for this syndrome. Complications include breakdown of muscle tissue which can progress to renal failure and Volkmann contracture, a non-reversible damage to the muscles of the forearm.
Whilst most compartment syndrome is acute following some kind of event, careful measurements of the pressures within the compartments of the leg have shown chronic compartment syndrome to be a clinical entity in situations such as excessive exercise performance. As the tissue pressure increases in the muscular and fascial compartment it starts to compromise the blood flow into the compartment, damaging the muscles and nerves. In the acute type the onset is fast and leads quickly to muscle and nerve damage which is irreversible unless treated urgently.
Shin splints in athletes have been regularly confused with chronic compartment syndrome, with the pain often on both sides and occurring after a particular period of exertion. The criteria for this condition vary in various pursuits and the abnormality can now be sought by pressure measurements. Open tibial fractures give the highest levels of compartment syndrome, with closed tibial fractures being much less risky for this condition. Vascular injuries may also precipitate compartment syndrome but vascular surgeons typically perform decompression at the time of repair if required.
For compartment syndrome to occur there must be either external or internal reasons for a raised pressure in the segments of the limb. External forces can include over tight clothes or boots and tight dressings or plasters. Internal factors can be numerous and include tissue swelling due to crush injury, fractures or internal tissue bleeding and even overdoing weightlifting. The muscles and the nerves are starved of blood due to the excessive pressure, causing chemical changes due to muscle necrosis which attract greater amounts of water into the compartment, increasing the pressure again. Eventually arterial blood flow is completely obstructed.
High compartment pressure need speedy surgical decompression as if it is left for six to ten hours the compartment will develop muscle death, nerve damage and more generalised tissue death. The damage to the muscles can allow the release of myoglobin into the circulation which can cause kidney damage which can be fatal. Chronic compartment syndrome is accompanied by an increase in the volume of muscles which increases the pressure, allowing this to remain raised between muscular contractions and interrupt blood flow. This develops into muscle cramps as the muscles are denied the required amounts of blood.
Compartment syndrome is normally managed by immediate surgical fasciotomy, with the muscle compartments being opened to permit pressure release and effect decompression. The surgeons may leave the wounds open for some time until the pressure eases and the local tissues settle.
Fasciotomy is the definitive surgical treatment for compartment syndrome, a cutting into the individual muscle compartments to allow the pressure to dissipate outwards and decompress the areas. The wounds may be left open for some days until the pressure subsides and the tissues recover. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in halifax. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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