The limb affected by compartment syndrome is often associated with a firm, wooden feeling on deep palpation. The symptoms of chronic exertional compartment syndrome, CECS, may involve numbness, tingling, or pain described as burning, cramping, sharp, or stabbing. These symptoms are brought on by exercise and consist of a sensation of extreme tightness in the affected muscles followed by a painful burning sensation if exercise is continued.
After exercise is ceased, the pressure in the compartment will decrease within a few minutes, relieving painful symptoms. This threshold can range anywhere from 30 seconds of running to about 10—15 minutes of running. CECS most commonly occurs in the lower leg, with the anterior compartment being the most frequently affected compartment. Failure to relieve the pressure can result in the death of tissues necrosis in the affected anatomical compartment, since the ability of blood to enter the smallest vessels in the compartment capillary perfusion pressure will fall.
This, in turn, leads to progressively increasing oxygen deprivation of the tissues dependent on this blood supply. Without sufficient oxygen, the tissue will die. Importantly, there is no difference in the incidence of compartment syndrome between open and closed fractures. Direct injury to blood vessels can lead to compartment syndrome by reducing the downstream blood supply to soft tissues. This reduction in blood supply can cause a series of inflammatory reactions that promote the swelling of the soft tissues. Such inflammation can be further worsened by reperfusion therapy.
Intravenous drug injection , casts , prolonged limb compression, crush injuries and eschar from burns can also cause compartment syndrome. Abdominal compartment syndrome occurs when the intra-abdominal pressure exceeds 20 mmHg and abdominal perfusion pressure is less than 60 mmHg. This disease process is associated with organ dysfunction and multiple organ failures. There are many causes, which can be broadly grouped into three mechanisms: primary internal bleeding and swelling ; secondary vigorous fluid replacement as an unintended complication of resuscitative medical treatment, leading to the acute formation of ascites and a rise in intra-abdominal pressure ; and recurrent compartment syndrome that has returned after the initial treatment of secondary compartment syndrome.
When compartment syndrome is caused by repetitive use of the muscles, it is known as chronic compartment syndrome CCS. CECS can be seen in athletes who train rigorously in activities that involve constant repetitive actions or motions. In a normal human body, blood flow from the arterial system higher pressure to venous system lower pressure requires a pressure gradient. When this pressure gradient is diminished, blood flow from the artery to the vein is reduced. This causes a backup of blood and excessive fluid to leak from the capillary wall into spaces between the soft tissues cells, causing swelling of the extracellular space and a rise in intracompartmental pressure.
This swelling of the soft tissues surrounding the blood vessels compresses the blood and lymphatic vessels further, causing more fluid to enter the extracellular spaces, leading to additional compression. This worsening cycle can eventually lead to a lack of sufficient oxygen in the soft tissues tissue ischemia and tissue death necrosis.
Tingling and abnormal sensation paraesthesia can begin as early as 30 minutes from the start of tissue ischemia and permanent damage can occur as early as 12 hours from the onset of the inciting injury. Compartment syndrome is a clinical diagnosis, meaning that a medical provider's examination and the patient's history usually give the diagnosis. Apart from the typical signs and symptoms, measurement of intracompartmental pressure can also be important for diagnosis. Fasciotomy is indicated in that case.
For those patients with low blood pressure hypotension , a pressure of 20 mmHg higher than the intracompartmental pressure is associated with compartmental syndrome. Chronic exertional compartment syndrome is usually a diagnosis of exclusion, with the hallmark finding being absence of symptoms at rest. Measurement of intracompartmental pressures during symptom reproduction usually immediately following running is the most useful test.
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Any external compression tourniquet, orthopedic casts or dressings applied on the affected limb should be removed. After removal of the external compression the limb should be placed at the level of the heart. The vital signs of the patient should be closely monitored. If the clinical condition does not improve, then fasciotomy is indicated to decompress the compartments.
An incision large enough to decompress all the compartments is necessary. This surgical procedure is performed inside an operating theater under general or local anesthesia. Some surgeons suggest wound closure would done seven days after fasciotomy. Chronic compartment syndrome in the lower leg can be treated conservatively or surgically. The pain you feel can be intense and can result in muscle….
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Types of compartment syndrome
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Recognizing the symptoms of compartment syndrome.
Symptoms of compartment syndrome
Long-term complications. Tests and diagnosis of compartment syndrome. If surgery is undertaken, some people may need a course of physiotherapy to help with the recovery process. This may help to restore a full range of motion and muscle strength. In acute compartment syndrome, the pressure needs to be relieved quickly. If it is not, cells may become permanently damaged or even die. Early diagnosis of compartment syndrome is vital to avoid long-term disability. Quick treatment can make sure the blood supply is restored to the affected area before any long-term damage occurs.
This is not the case in chronic compartment syndrome, which is usually resolved by stopping the exercise causing the problem. It is not usually dangerous. Article last reviewed by Wed 26 July All references are available in the References tab. Bae, D. Acute compartment syndrome in children: Contemporary diagnosis, treatment, and outcome [Abstract]. Journal of Pediatric Orthopaedics , 21 5 , Compartment syndrome. Middleton, C.
Understand Chronic Compartment Syndrome (CCS)
Compartment syndrome: the importance of early diagnosis. Nursing Times , 99 21 , MLA Barrell, Amanda. MediLexicon, Intl. APA Barrell, A. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Privacy Terms Ad policy Careers. Visit www. All rights reserved.
Optional Comments max. Send securely. Message sent successfully The details of this article have been emailed on your behalf. Table of contents What is it? Causes Symptoms Diagnosis Treatment Outlook. Fast facts on compartment syndrome: There are two kinds of compartment syndrome: acute and chronic.