What Is Compartment Syndrome?

Compartment syndrome is a serious condition that occurs when too much pressure builds up in a closed space within the body, typically surrounding muscles, nerves, and blood vessels. This pressure can restrict blood flow, leading to damage to the tissues in the compartment. It can happen in any part of the body, but it’s most common in the legs and arms.

There are two types of compartment syndrome:

• Acute compartment syndrome: Per the Cleveland Clinic, “Acute compartment syndrome happens suddenly (usually after a severe injury). It’s a medical emergency. Go to the emergency room right away if you think you have acute compartment syndrome. If it’s not treated immediately, acute compartment syndrome can cause permanent muscle damage, paralysis or death.”
• Chronic compartment syndrome: Long-term compartment syndrome typically builds up over time, usually after intense physical activity or exercise. Chronic compartment syndrome is not a medical emergency but can still be very painful.

What causes compartment syndrome?

Compartment syndrome can be caused by various factors that increase pressure within a muscle compartment, restricting blood flow and damaging tissues. Here’s a breakdown of the main causes.

Acute compartment syndrome

Trauma is the most common cause, including:

• Fractures: Particularly those of the legs and forearms, where fractures can cause swelling and bleeding within the compartment.
• Crush injuries: From car accidents, falling objects, or prolonged compression.
• Severe sprains or muscle contusions: Extensive swelling and bleeding from these injuries can increase pressure within the compartment.
• Surgery complications: Sometimes excess bleeding or swelling after surgery can lead to compartment syndrome.
• Tight dressings or casts: If applied too tightly, they can constrict the compartment and increase pressure.
• IV Infiltration: This occurs with Inadequate medical supervision of an Intravenous site which is improperly delivering the IV fluids outside of the vein and into the tissues resulting in swelling in the limb which must be treated surgically with fasciotomy to drain the excess fluids in an attempt to preserve the tissue and muscle. Compartment syndrome can result from this IV infiltration in adults and children.

Chronic compartment syndrome

• Repetitive activities: Engaging in activities that repeatedly stress specific muscle groups over time can gradually increase pressure within the compartment. This is common in athletes, runners, and dancers.
• Tight anatomy: Some individuals may have naturally tighter fascia (connective tissue) surrounding the muscle compartments, making them more prone to developing compartment syndrome with activity.

It’s important to note that the specific cause of compartment syndrome can vary depending on the individual and the circumstances. If you experience any symptoms suggestive of compartment syndrome, like severe pain, swelling, or weakness in a limb, especially after a personal injury or strenuous activity, seek immediate medical attention. Prompt diagnosis and treatment can help prevent permanent tissue damage and ensure a full recovery.

What are the treatments for compartment syndrome?

The treatment for compartment syndrome depends on whether the condition is acute or chronic.

Acute compartment syndrome

Emergency surgery (fasciotomy) is the primary treatment for acute compartment syndrome. It involves making incisions (fasciotomies) to release the pressure built up within the affected compartment. This surgery must be performed as soon as possible to prevent permanent tissue damage and improve the chances of a full recovery. Additional supportive measures may include:

• Pain medication: To manage pain and discomfort after surgery.
• Elevation: Keeping the affected limb elevated above the heart level to improve blood flow and reduce swelling.
• Antibiotics: To lessen the risk of infection.
• Physical therapy: To regain muscle strength and function after surgery.

Chronic compartment syndrome

• Activity modification: Avoiding or modifying activities that trigger symptoms is often the first line of treatment. This may involve switching to low-impact exercises, using orthotics, or taking rest periods.
• Physical therapy: Stretching, strengthening, and other exercises can help improve flexibility and reduce pressure within the compartment.
• Anti-inflammatory medications: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation.
• Surgery: If conservative measures can’t control symptoms, surgery may be recommended. However, this is typically less extensive than for acute cases and focuses on releasing specific areas of tight fascia within the compartment.

What are the long-term complications of compartment syndrome?

If left untreated or if the pressure is not relieved promptly, compartment syndrome can lead to various long-term complications, including:

• Muscle and nerve damage: Prolonged pressure within the compartment can result in damage to muscles and nerves. This damage can lead to weakness, numbness, tingling, and even paralysis of affected muscles.
• Permanent functional impairment: Severe cases of compartment syndrome can cause permanent impairment of muscle function, leading to difficulties with movement, strength, and coordination. This can significantly impact an individual’s ability to perform daily activities and may require long-term rehabilitation.
• Chronic pain: Individuals who have experienced compartment syndrome may continue to experience chronic pain, even after the initial injury has healed. This pain can be debilitating and may require ongoing management with medications, physical therapy, or other interventions.
• Complications from surgical treatment: In severe cases of compartment syndrome, surgical intervention may be necessary to relieve pressure within the affected compartment. Surgical procedures carry inherent risks, including infection, bleeding, and complications related to anesthesia.
• Psychological impact: Dealing with the long-term consequences of compartment syndrome, including chronic pain, functional impairment, and potential disability, can have a significant psychological impact on individuals. This may include feelings of frustration, depression, anxiety, and difficulties adjusting.

What are the five Ps of compartment syndrome?

Physicians use the “five Ps” to diagnose compartment syndrome, but it’s important to remember that not all five Ps are always present, especially during early diagnosis. However, the mnemonic goes as follows:

1. Pain (out of proportion): This is the most common and often the first symptom. The pain can be severe, burning, and worsen with activity or by stretching the affected muscle compartment.
2. Pallor (pale skin): The skin over the affected compartment may appear pale due to decreased blood flow.
3. Paresthesia (numbness or tingling): This symptom affects sensation in the affected area, causing numbness, tingling, or prickling sensations.
4. Paralysis (weakness): As pressure builds up, muscle function can be impaired, leading to weakness or difficulty moving the affected limb.
5. Pulselessness (weak or absent pulse): In severe cases, blood flow can be significantly reduced, making the pulse weak or even absent in the affected extremity.

If you experience any of these symptoms, especially pain that worsens with movement, seek immediate medical attention to prevent potential complications.

Remember, acute compartment syndrome is a medical emergency and warrants immediate treatment.

If you or a loved one are experiencing compartment syndrome after an accident or injury that wasn’t your fault, talk to the attorneys at Breakstone, White & Gluck today. We work to secure the financial compensation to which you’re entitled for your injuries and losses. To schedule a consultation, call our Boston offices or fill out our contact form today.