Compartment Syndrome - Symptoms, Causes, Treatment

Compartment syndrome is a medical condition in which pressure builds up within a compartment in the body. A compartment is an enclosed space that includes muscles, nerves, and blood vessels. 

This elevated pressure can impede blood flow, reducing oxygen supply to muscles and nerves. The condition can cause serious damage and be life-threatening. 

It most commonly occurs within the muscle compartments of the lower legs. However, it can also affect other areas of the body.

There are two main types of compartment syndrome. Each type has distinct characteristics and underlying causes. These types include:

1. Acute Compartment Syndrome: This is a sudden and potentially life-threatening condition. It usually occurs following a traumatic injury. The elevated pressure in this condition can lead to tissue damage, disability, or paralysis. Acute compartment syndrome, a medical emergency, requires immediate intervention. 

2. Chronic Compartment Syndrome: It develops gradually over time and is usually not an emergency. The condition is often associated with repetitive physical activity, like intense exercise. This type is also known as exertional compartment syndrome. 

Two other common types of compartment syndrome include:

1. Abdominal Compartment Syndrome: A critical condition where excessive pressure builds up within the abdominal cavity. This can prevent vital organs from receiving blood and oxygen. Abdominal compartment syndrome can result from trauma, surgery, or medical conditions. It requires prompt medical intervention to relieve pressure and prevent complications.

2. Anterior Compartment Syndrome: It involves increased pressure in the muscle compartment located at the front of the lower leg. Anterior compartment syndrome often occurs due to swelling from direct trauma (acute) or overuse (chronic).

Compartment syndrome can present with various signs and symptoms, whether acute or chronic. Here are the common symptoms and signs of compartment syndrome to look out for:

Acute compartment syndrome signs and symptoms are described by the five “P” s. The 5 Ps of compartment syndrome are as follows:

1. Pain: It is the most common symptom of acute compartment syndrome. Patients may experience severe, persistent, and unrelenting pain disproportionate to the injury or condition. Pain may worsen by touch, stretching, or pressure. 

2. Pallor: The lack of blood may cause paleness or diminished skin coloration over the affected compartment.

3. Paraesthesia: Prickling, tingling, or abnormal sensations in the region, similar to pins and needles.

4. Pulselessness: Weakened or absent pulse in the affected area

5. Paralysis: Weakness or difficulty moving the affected muscles, potentially leading to partial or complete paralysis.

The most common symptom of chronic syndrome is pain or cramping. The pain usually subsides within 30 minutes of discontinuing the exercise. Other symptoms of chronic compartment syndrome may include:

1. Difficulty moving the foot

2. Visible muscle bulging

3. Numbness

A severe injury or excessive physical activity can lead to swelling or bleeding within a compartment. This swelling or bleeding generates pressure on both the nerves and muscles. 

In cases where this pressure becomes excessive, the affected area does not get an adequate blood supply. This diminished blood flow can result in tissue death, potentially causing irreversible damage to the affected area. 

Causes of acute compartment syndrome include:

1. Fracture: Bone fractures can increase pressure within a compartment. This is especially true for fractures involving multiple pieces of bone. It can lead to compartment syndrome.

2. Crush injuries: When a body part is trapped or crushed, it can cause swelling and pressure buildup within the affected compartment.

3. Severely Bruised Muscle: These muscles can trigger inflammation and swelling within a muscle compartment. This increases pressure and impedes blood flow.

4. Tight Dressings or Casts: Applying tight dressings or casts can restrict blood flow and increase pressure within a compartment.

The primary cause of chronic compartment syndrome includes exercise, especially those involving repetitive motions. These exercises may include:

1. Running

2. Swimming

3. Playing tennis

4. Biking

5. Intense or frequent workouts

Several factors can increase the risk of compartment syndrome and contribute to the elevated pressure within muscle compartments. The risk factors for acute and chronic compartment syndrome are as follows:

Acute Compartment Syndrome

1. Age: This syndrome type is more common in males younger than 35. This is probably due to this group's larger relative intracompartmental muscle mass. It can also be due to the increased probability of these people engaging in high-energy trauma. 

2. Tibial Shaft Fracture: Individuals with a tibial shaft fracture (fracture of bones in the lower leg) are more prone to acute compartment syndrome. According to NCBI, tibial shaft fracture has a 1-10% incidence of compartment syndrome. 

3. Bleeding Diathesis: Individuals with bleeding diathesis like haemophilia have an increased risk of the disease. Bleeding diathesis impairs the body’s ability to control bleeding, leading to increased pressure and potential tissue damage.

Chronic Compartment Syndrome 

1. Age: Anyone can develop chronic compartment syndrome. However, it is most common in male and female athletes under 30. 

2. Type of Exercise: Repetitive high-impact activities like running increase the risk of developing this condition. 

3. Overtraining: Pushing oneself too hard or too often can elevate susceptibility to chronic exertional compartment syndrome.

Since acute compartment syndrome results from accidents or injury, individuals cannot always prevent the condition. However, they can prevent complications by seeking prompt diagnosis and treatment. 

One known way to prevent this condition is to check if the splint or cast is too tight. If it feels tight, patients should inform their healthcare provider to get it adjusted. 

On the other hand, chronic compartment syndrome can be prevented. Some measures to prevent this condition include:

1. Building Exercise Endurance: Gradually increase exercise intensity and duration. It allows muscles to adapt and reduce the risk of overuse.

2. Improving Flexibility: Enhanced flexibility reduces muscle tension and strain. This helps alleviate pressure within compartments during exercise.

3. Choosing Softer Surfaces: Exercising on softer surfaces, like grass or padded tracks, absorbs shock and reduces muscle impact. 

4. Changing Body Positions: Varying movement patterns minimise repetitive stress on specific muscle groups, preventing excessive swelling and pressure buildup.

5. Appropriate Footwear: Well-fitting, supportive footwear can help minimise impact during activities.

6. Avoiding Overtraining: Adequate rest between workouts prevents excessive muscle fatigue and swelling, reducing the likelihood of compartment syndrome.

Early diagnosis prevents complications. If compartment syndrome is suspected, timely intervention is necessary to relieve pressure and restore blood flow. The following is an overview of the diagnostic process for compartment syndrome:

1. Physical Examination: The healthcare provider conducts a thorough physical examination to assess the affected area. They will look for signs that indicate other conditions. This may include checking tendons for tendinitis or shins for shin splits. 

2. Compartment Pressure Measurement Test: This diagnostic tool for suspected compartment syndrome is crucial. The healthcare provider inserts a needle into the affected compartment.

   A machine attached to the needle directly measures the pressure. The doctor may insert the needle in different compartments to check the pressure. 

3. Repeat Pressure Test: The doctor may repeat the pressure test after exercise for chronic compartment syndrome. Resting pressure and pressure after exercise may be compared to determine if pressure is abnormally elevated.

4. Imaging: Tests like X-rays may be used to assess the underlying cause, such as fractures or soft tissue injuries. 

How to Prepare for a Doctor’s Appointment?

Preparing for a compartment syndrome appointment can help individuals gather all relevant information regarding their condition. It aids in making informed decisions about managing the condition. Here’s a checklist to help prepare:

1. Medical History: Patients must list their past and current medical conditions, surgeries, and injuries. Include details about recent activities or exercises that might have triggered the symptoms.

2. Symptoms: They should document all the symptoms they experience. It includes the symptoms from the beginning, its intensity, and any changes over time. Patients must also inform the doctor whether these symptoms occur during specific activities or at rest.

3. Exercise Routine: Individuals must describe their typical exercise routine. This includes their activities, frequency, intensity, and any recent changes.

4. Medications: It is advised to list all medications, supplements, and herbs a person takes. This helps the doctor determine any potential drug interactions. 

5. Questions to Ask: Patients can benefit by preparing a list of questions to discuss with the healthcare provider. It might include inquiries about potential causes, diagnostic tests, treatment options, and expected outcomes.

What to Expect from the Doctor?

During a compartment syndrome appointment, the doctor will likely ask the patient various questions. This helps them understand the patient’s symptoms, medical history, and potential triggers. Here are some questions patients might expect:

1. When did you first notice your symptoms? 

2. Can you describe the onset and progression of your symptoms?

3. How severe are the symptoms?

4. Does anything seem to improve or worsen these symptoms?

5. Do you experience numbness, tingling, or weakness in the affected area?

6. Have you recently experienced any injuries, trauma, or accidents? If yes, please provide details.

7. Are your symptoms associated with specific activities or exercises? Does the pain worsen during certain movements or exercises?

8. How soon do the symptoms start after commencing activity?

9. How long do the symptoms last after stopping the activity?

10. Have you recently changed your exercise routine, footwear, or equipment?

Questions to Ask the Doctor

Patients must ask questions during a compartment syndrome appointment to better understand their condition and potential treatment options. The following are some questions they might consider asking their doctor:

1. What are the potential causes of my symptoms?

2. Are there any other possible causes of these symptoms?

3. What tests will I need for diagnosis?

4. Is my condition acute or chronic?

5. What are the available treatment options for compartment syndrome? Which one do you recommend?

6. Will I need surgery?

7. Can you explain the benefits and risks associated with each treatment option?

8. How urgent is the need for treatment in my case? 

9. How can I manage my other health conditions with compartment syndrome?

10. What lifestyle modifications or changes in physical activity would you recommend to prevent the recurrence of compartment syndrome?

11. Should I see a specialist for further evaluation or treatment?

Don’t hesitate to ask any questions that come to mind, and feel free to take notes during the appointment.

Compartment syndrome treatment depends on whether it is acute or chronic. The management of the syndrome also depends on the severity of the condition. The following is an overview of treatment approaches for these conditions:

Treatment Without Surgery 

Chronic compartment syndrome usually disappears when an individual stops exercising. If the symptoms do not improve, the doctor may recommend some nonsurgical treatment options. However, remember that acute compartment syndrome is a medical emergency that can be treated with surgery only. Treatment for chronic compartment syndrome without surgery includes:

Lifestyle Changes

1. Physical Therapy: Engaging in targeted physical therapy exercises to improve muscle flexibility and reduce symptoms.

2. Low-Impact Exercises: Incorporating low-impact activities into the exercise routine to minimise strain on muscles.

3. Surface Change: Choosing softer or padded surfaces for exercise to decrease the impact on muscles.

4. Activity Modification: Resting after physical activity or modifying the intensity and duration of exercises to prevent symptoms from worsening

5. Elevation: Elevating the affected limb to alleviate swelling and pressure.

6. Anti-Inflammatory Medication: Using anti-inflammatory medications under medical guidance to manage pain and inflammation.

7. Icing: Applying ice to the affected area after exercise to help reduce inflammation and discomfort.

Ayurveda

1. Svedam (Fermentation): In Ayurveda, applying warm compresses or fermentation to the affected area can help alleviate pain and reduce inflammation. This is done by gently warming a cloth or herbal poultice and placing it on the painful region.

2. Abhyanga (Oil Massaging): Massaging the affected area with specific oils can provide relief. The gentle massage helps improve blood circulation and relax muscles. It's like giving your muscles a soothing hug!

3. Pain-Relieving Lepa Application: Ayurvedic lepas, or herbal pastes, can be applied to the area to reduce pain and swelling. Think of it as a natural, soothing ointment that eases discomfort.

4. Medications: Ayurvedic medicines can also play a role in managing compartment syndrome:

   1. Dasamoolarishtam: This herbal concoction helps reduce inflammation, which is often a key factor in compartment syndrome. It's like an anti-inflammatory superhero for your body.
   2. Rasraj Ras: If you're dealing with neuromuscular issues alongside compartment syndrome, this medicine can come to your rescue. It helps in improving nerve and muscle function.
   3. Laksha Guggulu: When your bones are affected, Laksha Guggulu is effective. It helps in treating bone-related problems, providing support to your skeletal system.
   4. Trayodasanga Guggulu: Inflammation can be a major source of pain in compartment syndrome, and this medicine specifically targets inflammation, helping to ease your discomfort.
   5. Mahayogaraja Guggulu: If ligament pain is your concern, Mahayogaraja Guggulu can be used to provide relief. It's like a soothing balm for your ligaments.

Treatment With Surgery

The primary treatment for acute compartment syndrome is a surgical procedure called a fasciotomy. Itmay also be considered for the chronic form of the condition if conservative measures do not provide relief.

1. Compartment syndrome fasciotomy involves making incisions in the fascia surrounding the affected compartment. It helps relieve pressure and restores blood flow. 

2. After the swelling and pressure subsides, the surgeon closes the incision. 

3. Sometimes, the swelling may not go away immediately. In these severe cases, the surgeon may take a graft from another body area before closing the incision. 

Please Note: The selection of the compartment syndrome management approach is based on the patient’s condition and the treating doctor’s opinion. 

Cost of Compartment Syndrome Surgery 

Generally, the cost of fasciotomy in India ranges between ₹ 40,000 and ₹ 90,000. However, the price can vary widely for different individuals. 

Several factors can affect the cost of the procedure. These factors include:

1. Type of Hospital: Fasciotomy cost can vary depending on the type of healthcare facility. Cost in private hospitals is usually higher than in government hospitals. 

2. Surgeon’s Fees: The experience and expertise of the surgeon can affect the fasciotomy cost. 

3. Diagnostic Tests: The overall cost of the procedure may vary depending on the diagnostic tests performed.

4. Hospital Stay: Cost can vary depending on the duration of the hospital stay.

5. City or Location: Healthcare costs can vary from one city to another. Furthermore, the cost is usually higher in urban than rural areas.

Compartment syndrome can give rise to a range of serious complications, particularly if not treated promptly and effectively. A more detailed exploration of compartment syndrome complications is as follows:

1. Muscle and Nerve Damage: Acute compartment syndrome may lead to permanent muscle and nerve damage within hours. This happens when patients do not receive immediate medical attention. 

   Chronic compartment syndrome is not an emergency. However, exercising when in pain can also cause permanent damage to the muscles, blood vessels, and nerves.

2. Limb Loss: In the most severe and untreated cases of acute compartment syndrome, individuals may need an amputation. Delayed treatment can be life-threatening.

3. Volkmann’s Ischemic Contracture: In severe cases, compartment syndrome can lead to muscle ischemia (reduced blood supply) in the forearm. This condition is known as Volkmann’s ischemic contracture. 

4. Infection: The compromised blood flow can also increase infection risk in the affected tissues.

5. Rhabdomyolysis: Reduced blood flow and tissue necrosis in a compartment can lead to the release of muscle proteins in the bloodstream. This condition is known as rhabdomyolysis.  

When to See a Doctor?

Compartment syndrome requires prompt diagnosis and intervention to prevent serious complications. Individuals should call a doctor immediately if they experience severe or rapidly worsening symptoms. These include:

1. Severe, unrelenting pain

2. Numbness or tingling

3. Muscle weakness or paralysis

4. Skin discolouration

5. Pulselessness

6. Swelling and tightness

7. Reduced sensation

Diet for Compartment Syndrome

Compartment syndrome or a fasciotomy procedure requires a balanced diet that promotes healing and overall well-being. Patients should consult a dietician for a personalised nutrition plan. Here are general dietary considerations:

1. Protein: Foods rich in protein support tissue repair and recovery. Examples include:

1. Fish

2. Meat

3. Nuts

4. Soy products

2. Vitamins and Minerals: Eat fruits and vegetables for essential vitamins and minerals like vitamin C. It helps with wound healing. 

3. Anti-Inflammatory Food: An anti-inflammatory diet after fasciotomy can help reduce post-operative swelling. It also promotes tissue healing and manages pain more effectively. Anti-inflammatory foods include:

1. Berries

2. Avocados

3. Mushroom

4. Tomatoes

5. Broccoli

6. Pepper

7. Fatty fish 

8. Green tea

Compartment syndrome emerges as a critical medical concern with the potential for severe consequences if left unchecked. Timely recognition of symptoms and prompt medical intervention are paramount in preventing irreversible tissue damage. It is important to consult a healthcare professional if you experience any symptoms related to compartment syndrome. 

The team at HexaHealth offers comprehensive information on symptoms, diagnosis, and treatment options for compartment syndrome. We empower patients to understand their condition better, make informed decisions, and access relevant medical guidance. So what are you waiting for? Schedule an appointment with HexaHealth TODAY! 

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