What is compartment syndrome?
Compartment syndrome is a painful condition caused by bleeding or swelling within an enclosed bundle of muscles (a muscle ‘compartment’). Each group of muscles in the arms and legs, together with the blood vessels and nerves, is contained in an enclosed space surrounded by layers of tissue called fascia. The tough fascia keeps the tissues in place and does not easily stretch or expand, so the pressure inside the compartment can easily increase if bleeding or swelling occurs.
Compartment syndrome can happen suddenly, after an injury, or gradually after a long period of repetitive-motion exercise, such as running or cycling. This is called chronic compartment syndrome.
How do we treat compartment syndrome at the Mansfield Clinic?
Acute compartment syndrome is a medical emergency, and needs to be dealt with in hospital. Chronic compartment syndrome is much less serious, and the challenge is always to make the diagnosis. Other causes of muscle pain, such as tendinitis, have first of all to be ruled out. Dr Allfree will give you a thorough assessment and examination. If he thinks you have chronic compartment syndrome, he will give you appropriate advice and treatment.
The symptoms depend on whether you have acute compartment syndrome – which happens suddenly, after an isolated injury – or chronic compartment syndrome, which comes on gradually with repetitive exercise. Acute compartment syndrome causes intense pain, especially when the affected muscle is stretched. You may also have a tingling or burning feeling in the skin, and the muscle may feel tight. It usually happens after a fracture or a crush injury. It is a medical emergency because the high pressure inside the compartment can potentially cause permanent muscle and nerve damage. Compartment syndrome can also happen after a broken arm has been put into a plaster cast while the swelling is still happening, and the cast itself becomes the ‘compartment'. Acute compartment syndrome will be diagnosed and treated by hospital doctors, usually when you are in the hospital emergency department after an accident. Dr Allfree does not treat acute compartment syndrome at the Mansfield Clinic.
Chronic compartment syndrome causes cramping pain during exercise, mostly in the leg, that eases when the activity is stopped. You may also have difficulty moving the foot and visible muscle bulging. It is much less serious than acute compartment syndrome. It comes on gradually, usually after a long period of repetitive-motion exercise, such as running or cycling. Diagnosis of chronic compartment syndrome is made when other causes of muscle pain, such as tendonitis, have been ruled out.
Symptoms happen because the swelling or bleeding increases the pressure inside the compartment. When this pressure exceeds the pressure inside the veins, blood cannot flow into and out of the muscles properly. Oxygen and nutrients cannot get to the muscles and nerves, and this leads to tissue damage. If you go on to develop numbness or paralysis, it usually means there is permanent tissue damage.
Compartment syndrome usually occurs in the legs, feet, arms or hands, but it can occur wherever there is an enclosed compartment inside the body. If it happens in the buttocks it can result in damage to the sciatic nerve (which runs down your lower back and legs) and disability.
Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency fasciotomy. The doctor will make an incision to cut open your skin and fascia surrounding the muscles, to immediately relieve the pressure inside the muscle compartment and prevent permanent tissue damage. The wound will be closed 48-72 hours later.
The most important aspect of treatment is making the correct diagnosis, and it is important that other causes of muscle pain are considered and ruled out first. Dr Allfree has a specialist interest in sport-related injuries, and has a lot of experience in diagnosing musculoskeletal pain. Chronic compartment syndrome is usually not dangerous and can sometimes just be relieved by stopping the exercise and choosing low-impact activities instead. Physical therapy such as osteopathy, orthotic shoe inserts and anti-inflammatory medicines may help. Surgery will only be recommended if your symptoms persist despite the above measures, in which case Dr Allfree will be able to arrange appropriate referral.