Compartment Syndrome

Compartment syndrome is the result of the tissues in one of the soft tissue limb compartments being deprived of sufficient blood flow due to the pressure in the compartment overwhelming the pressure in the vessels trying to bring blood in. The local tissues can suffer necrosis and die with high levels of pain if treatment is not quickly engaged. The calf and the forearm are the commonest body parts to suffer this as the muscle groups are wrapped up in relatively inextensible compartments bounded by bone and fascia (firm connective tissue). The firm nature of the compartments makes any pressure build up within them potentially dangerous.

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.

Acute onset of compartment syndrome is the most common presentation after a traumatic event, chronic compartment syndrome has been described secondary to excessive exercise by measuring the pressure occurring within the leg compartments. Inside the compartment composed of the muscle and fascia the pressure rises, steadily reducing the blood flow into the area until muscle and nerve damage occurs. Acute compartment syndrome comes on quickly with the irreversible damage following closely after unless it is treated promptly.

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.

Two kinds of factors are important for triggering compartment syndrome, either internal or external factors acting on the area. Wearing clothes too tight and the application of plasters or dressings too tightly can produce the required compression. Many potential internal factors exist such as swelling from a crushing injury, bleeding internally, doing excessive muscle building and fractures. As the pressure rises and overwhelms the blood pressure then blood flow stops, damaging the muscles and nerves and causing muscle death, leading to chemical changes which pull water into the compartment, increasing the pressure again.

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.

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

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