Dealing With Compartment Syndrome

The reason for compartment syndrome is the excessive build up of pressure in one of the tissue compartments of the limbs, stopping the arterial pressure from supplying the area and depriving the tissues of adequate blood supply. Death of the local tissues with significant pain can occur if treatment is not promptly administered. The forearm and the lower leg are the most common sites for this to occur, in which areas the muscles are bounded by a semi-rigid compartment made up of firm connective tissue fascia and by bone. If the pressure builds up inside here its lack of extensibility can cause problems within the compartment.

The most common cause of compartment syndrome is a fracture of the tibia but there are other potential causes which include tissue crush injuries, tight dressings and plasters, other fractures and damage to blood vessels. If the syndrome develops the signs and symptoms are a loss of feeling in the area, loss of pulses and loss of the ability to move the limb. Surgical decompression is the primary form of management for diagnosed compartment syndrome. Potential complications include kidney failure, breakdown of muscle tissue and permanent contracture of the forearm muscles.

A traumatic event is the most common precipitating factor for compartment syndrome in the acute mode, but enthusiastic performance of exercises can show measureable increases in the pressure in a compartment, leading to a diagnosis of chronic compartment syndrome. The nerves and muscles are damaged by the acute loss of blood coming into the compartment due to the pressure gradually rising inside an inextensible area. Irreversible tissue damage can occur after the rapid acute onset of compartment syndrome without prompt management.

The athletic condition shin splints may be related to chronic compartment syndrome, the pain typically occurring in both legs and after a particular exercise period has elapsed. The criteria for diagnosing the problem are specific to particular activities and the problem can now be diagnosed via pressure measuring. The highest risk of this syndrome occurs after open fractures of the shin bone, with closed fractures being much less likely to cause problems. Injuries to the blood vessels can also set off compartment syndrome but this is dealt with by the vascular surgeons who decompress the area at surgery.

If compartment syndrome is going to be present there have to be either internal or external reasons for the heightened pressure in the limb segments. Outside contributing factors can be clothes which are too tight or similar dressings or plasters. Internal factors may be many and cover tissue oedema secondary to crush injury, internal bleeding, fractures and even doing too muscle building. The pressure levels exceed the blood pressure and this starves the nerves and muscles, allowing muscle tissue death with chemical changes attracting large amounts of water into the areas, further increasing the pressure. Arterial blood flow can be fully compromised eventually.

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.

Diagnosis of acute lack of blood to a limb can be indicated by limb pallor, pulse loss, pins and needles, pain and coldness of the leg, however these signs are not reliable in terms of diagnosis in clinical practice. Presentation may be of unexpectedly elevated levels of pain not seemingly related to the injury level, with an aching, deep pain which is worse on muscle stretching. On examination of the limb it should be clear whether there is any likelihood of internal tissue damage. Sensory testing can be helpful as pressure shows more obviously in sensory nerve function.

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.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, Physiotherapists in Bournemouth, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.