Compartment Syndrome

Compartment syndrome is a condition that develops when the pressure inside the fascia surrounding the muscles and bone increases without relief and can cause destruction of the capillaries and nerve cells inside. Compartment syndrome can develop in any of the compartments in the body but is most common in the lower leg. This may develop acutely, from an injury or other cause of immediate swelling, or chronically, as a result of overuse or other chronic swelling.

Pain, numbness, a feeling of pressure, and some swelling usually accompany this condition. Acute compartment syndrome is a medical emergency whereas the chronic syndrome, although still painful and a danger to the blood vessels and nerves, can be treated more conservatively. Both conditions must be treated, however, to prevent permanent damage to the injured area and those distal to the injury as well.

Athletes involved in high impact collision and contact sports, such as football and rugby, are more susceptible to acute compartment syndrome, while those involved in repetitive activities, such as running and jumping, may be more vulnerable to chronic compartment syndrome.

What is Compartment Syndrome?Muscles are covered by tough fibrous tissue called fascia. This tissue wraps around the muscles and accompanying bone and holds it all in place, forming a compartment. The fascia is large enough to accommodate the bone, nerves, blood vessels, and muscle at its current size. There is just enough stretch in the fascia to allow the normal expansion of the muscle from increased blood flow due to exercise. If the muscle swells or blood collects inside the compartment the pressure will rise. If the pressure exceeds that of the capillaries (usually around 30 mmHG) they will begin to die. This in turn will cause death to the nerve and muscle tissue around them due to loss of blood supply.

Compartment Syndrome Types: Anterior and Posterior. Acute and Chronic.Compartment syndrome is most common in the lower leg, although it can happen along any long bone, especially with a fracture. The quadriceps muscle is another likely candidate for this condition but due to its size and the lesser incidence of injury it is still far less common than lower leg compartment syndrome.

In the lower leg, compartment syndrome usually involves either the anterior compartment, over the front lateral side of the shin, or one of the posterior compartments, behind the tibia. The posterior area consists of the superficial compartment and the deep compartment. The lateral compartment is the fourth compartment in the lower leg. The anterior compartment is the most commonly injured of the four compartments.

Acute compartment syndrome results from trauma to the muscle or bone in the compartment. This trauma leads to bleeding inside the compartment. As the blood builds up in the compartment, with nowhere to go, the pressure increases. Because this happens at a fairly rapid rate (sometimes within minutes, other times over a period of hours) the pressure can build to a high level and cause serious damage to the nerves and blood vessels.

Chronic compartment syndrome is usually the result of overuse. The muscle becomes inflamed and swells over time and with rest returns to near normal. This causes pressures that are high at times and this high pressure over time can cause damage to the blood vessels and nerve tissue. The longer the pressure is elevated the more damage results.

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