Compartment Syndrome

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Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Covering these tissues is a tough membrane called a fascia. The role of the fascia is to keep the tissues in place, and, therefore, the fascia does not stretch or expand easily.

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous and life-threatening levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Compartment syndrome can be either acute or chronic. Acute compartment syndrome requires a medical emergency. Therefore, it is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.

Chronic compartment syndrome, also known as ‘exertional’ compartment syndrome, is typically not as severe as acute compartment syndrome. Compartment syndrome develops when swelling and bleeding occurs within a compartment. Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted, so without a steady supply of oxygen and nutrients, nerve and muscle cells may be damaged. In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. Fortunately, this does not usually happen in chronic compartment syndrome. Additionally, this condition often occurs in the anterior compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.

Causes & Symptoms

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As mentioned, compartment syndrome can occur in both levels of severity, which are either acute or chronic:

 

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 are associated with acute compartment syndrome include:

 

  • A fracture or crush injuries.

 

  • Re-established blood flow that occurs after blocked circulation. This may happen 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 a long period of time in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most patients will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this type of manner normally occurs in patients who are neurologically compromised. This can happen after severe intoxication with alcohol or drugs.

 

  • A bruised muscle. For example, a motorcycle falling on the leg of the rider, or a football player being hit in the leg with another player’s helmet.

 

  • Taking steroids (such as anabolic steroids) is a possible risk 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.

 

Chronic compartment syndrome – The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in sports activities with repetitive motions, such as running, biking, or swimming are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise and is normally not as dangerous as acute compartment syndrome.

Other types of symptoms linked to compartment syndrome include:

 

  • The pain is much more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.

 

  • A tingling or burning sensation in the skin (paresthesia) in the skin.

 

  • The muscle may feel tight or full.

 

  • Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.

 

  • Difficulty moving the foot.

 

  • Visible muscle bulging.

Who Can Get Compartment Syndrome?

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Certain risk factors increase your risk of developing compartment syndrome, including the following:

 

  • Aging – Although anyone can develop compartment syndrome, the condition is most common in male and female athletes under the age of 30.

 

  • Type of exercise – Repetitive impact activity, such as running, increase the risk of developing compartment syndrome.

 

  • Tightness from bandages / casts – Patients who have compartment syndrome and are currently wearing either a bandage or a cast may have a chance of experiencing a complication if applied too tightly, or due to swelling that occurs after casting.

 

  • High-intensity training – Working out with high intensity or too frequently also raises your chance of developing compartment syndrome.

 

Generally, acute compartment syndrome occurs as a complication of an injury. Often it is due to a fracture of the radius or ulna in the forearm or the tibia and fibula in the lower leg that causes significant bleeding in one or more of the compartments.

Other abrupt risk factors of compartment syndrome include burns.

Chronic compartment syndrome usually occurs because of excessive exercise, where repetitive motion and muscle use cause localized swelling and irritation. Most often, symptoms in the legs are seen with runners and bicyclists and in the arms of swimmers.

How Does It Affect You? How Serious Is It?

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When a patient experiences an acute compartment syndrome, this normally requires immediate medical attention to relieve pressure. Permanent damage to your muscles and nerves can develop within hours. This is a surgical emergency and could necessitate an amputation if not addressed immediately. Chronic compartment syndrome isn’t considered an emergency situation; however, it is recommended to seek a doctor and know if you are experiencing any symptoms linked to compartment syndrome. Do not try to exercise when you are in pain, as this can cause permanent damage to your muscles, blood vessels, and nerves. Unfortunately, you can’t prevent acute compartment syndrome caused by an accident or injury, but you can seek early diagnosis and treatment to prevent any further complications.

Recommended Treatment & Rehabilitation

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Your doctor will first give you a physical exam to check for signs of acute or chronic compartment syndrome. They may squeeze the injured area to determine the severity of your pain. Your doctor may also use a pressure meter with a needle attached to measure how much pressure is in the compartment. This measurement needs to be taken while you are doing the activity that makes your leg or arm hurt. It will be taken again after you have finished the first time. Lastly, your doctor may take X-rays to rule out other conditions associating with compartment syndrome.

If you are diagnosed with compartment syndrome, a physiotherapist will work in a treatment programme due to the condition, whether it requires surgical treatment or not. Your physiotherapist will then work with you to design an individualized treatment plan based on your condition and personal goals. Your physiotherapist may recommend:

 

Range of motion exercises

 

Restricting the motion of your knee, foot, or ankle may be causing increased strain in the muscles housed within the compartments of your lower leg. Stretching techniques can be used to restore motion in these affected joints to help reduce undue muscle tension.

 

Manual therapy

 

Your physiotherapist may use their hands to move and manipulate muscles and joints to improve motion and strength. These techniques can target areas that are difficult to treat on your own.

 

Muscle-strengthening

 

Hip and core weakness can influence how your lower body moves and may cause imbalanced forces through the lower-leg muscle groups that may contribute to compartment syndrome. Building core strength (for example in the muscles of the abdomen, lower back, and pelvis) is highly important; a strong midsection allows greater stability through the body, better supporting arms and legs when perform different motions. For athletes engaged in endurance sports, it is important to have a strong core to help stabilize the hip and knee joints during repetitive leg motions. Your physiotherapist will be able to determine which muscles are weak and provide specific exercises to target these areas.

 

Modalities

 

Your physiotherapist may use modalities (ultrasound, iontophoresis, moist heat, cold therapy) as a part of your rehabilitation program. These tools may help improve tissue mobility and flexibility and enhance recovery. Therefore, your therapist will discuss the purpose of each modality with you.

 

Educational advice 

 

Your treatment should include educational advice about how to safely return to your previous activities, particularly if your condition requires a fasciotomy. Your physiotherapist may recommend:

 

  • Wearing supportive footwear.

 

  • Choosing more appropriate surfaces and terrain for exercises, especially endurance sessions.

 

  • Limiting your pace in certain activities.

 

  • Avoiding some activities altogether.

 

  • Adapting strategies for recovery and maintenance of good health (allowing your muscles and joints proper rest time).

 

  • Making changes in your workplace to help lower the risk of injury.

 

Common treatments for compartment syndrome focus on reducing the dangerous pressure in the body compartment. Dressings, casts, or splints that are constricting the affected body part should ideally be removed where practical. Other supportive treatments include:

 

  • Keeping the body part below the level of the heart (to improve blood flow into the compartment).

 

  • Giving oxygen through the nose or mouth.

 

In some cases, abdominal compartment syndrome treatments include life support measures like mechanical ventilation, medicines to support blood pressure (vasopressors), and kidney replacement therapies (such as dialysis). Surgery to open to the abdomen in order to reduce the compartment syndrome pressures may be necessary. The best time to perform surgery in patients with abdominal compartment syndrome is often not clear – surgery for abdominal compartment syndrome may be lifesaving, however, can also cause complications.

In most severe cases due to compartment syndrome, surgery is the last option to prevent further acute / chronic symptoms regarding this condition. The surgeon (either an orthopedic or general surgeon) will perform a fasciotomy, an operation where the thick, fibrous bands that line the muscles are filleted open, allowing the muscles to swell and relieve the pressure within the compartment. Depending upon the amount of swelling, a second operation may be required later to close the skin after the swelling has been resolved.

Alternative & Homeopathic Treatment

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While eating a diet high in anti-inflammatory foods, exercising in a healthy manner, resting enough between workouts, and stretching after workouts can all help lower swelling, these habits still might not be enough to prevent compartment syndrome in some cases. It’s a good to practice these things anyway since they prevent injuries and pain in addition to lowering the risk for compartment syndrome, but if it is already set in, you must start treatments right away. The goal of treating compartment syndrome at home is to help reduce pressure and improve blood-flow to the area that is affected. Therefore, here are a few home remedies that can reduce further symptoms of compartment syndrome:

 

  • Orthotics – Orthotic inserts are soft but a firm foot or heel pads that are inserted into the shoe. When positioned correctly, inserts can correct abnormal foot posture and relieve muscle pain caused by walking and running.

 

  • Limiting your physical activities – especially focusing on low-impact activities such as cycling.

 

  • Pain relievers – Taking pain medications orally such as NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen to help reduce swelling and inflammation due to chronic compartment syndrome.

 

  • Ice application – Applying ice packs 15-20 minutes a day to help reduce inflammation.