Compartment Syndrome

By Joan McLoud, Physical Therapist

Compartment Syndrome Overview

Compartment syndrome is a condition in that increases pressure in the muscle compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the arm and leg are the most common.

The components of this condition are symptoms, diagnosis, treatment, and rehab or aftercare.

Acute Compartment Syndrome

Acute compartment syndrome(ACS) symptoms can include severe pain, poor pulses, decreased ability to move, numbness, or pale color of the affected limb. It is most commonly due to physical trauma such as a bone fracture or crush injury. Diagnosis is generally based upon a person’s symptoms. Treatment is by surgery to open the compartment promptly. If not treated with about 6 hours, permanent muscle or nerve damage can result.

Chronic Compartment Syndrome

In chronic compartment symptoms, there is generally pain with exercise. Other symptoms may include numbness. Symptoms typically resolve with rest. Common activities that trigger chronic compartment syndrome include running and biking. Generally, this condition does not result in permanent damage. Treatment may include physical therapy or, if that is not effective, surgery. The surgery for this condition is a Fasciotomy.

How the body handles this condition

Groups of organs or muscles are organized into areas called compartments. Strong webs of connective tissue called fascia form walls of these compartments. After an injury, blood or edema (fluid resulting from inflammation or injury) may accumulate in the compartment. Severe tissue damage can result when pressure builds in these areas.

Causes 

A broken leg or arm  can cause acute compartment syndrome and it develops rapidly. This condition can develop from the fracture itself or treatment after casting or surgery.

Symptoms  

There are five characteristic signs and symptoms related to this condition:
Pain, paraesthesia (reduced sensation), paralysis, pallor, and the lack of a pulse. Pain and paraesthesia are early symptoms of this condition.

Diagnosis

Intracompartmental pressure can also be important for diagnosis.  The clinician will insert an instrument 5cm into the zone of injury.  Higher than 30 mmHg of the diastolic pressure is associated with this syndrome.

Treatment of Compartment Syndrome 

Fasciotomy is indicated in the above conditions—surgery to release the pressure in the area.  The area needs to be left open as the condition heals.  Chronic compartment syndrome can be treated conservatively or surgically. Conservative treatment consists of rest, anti-inflammatory medications, and manual decompression.  The key to successful treatment of compartment syndrome is early diagnosis and effective treatment. Although this condition does not happen all the time, the more we are aware of signs and symptoms, the faster we can seek treatment.

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By:  Joan McLoud, PT