Compartment syndrome is an acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use, in which increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply. Without prompt treatment, it may lead to nerve damage and muscle death. This condition is most commonly seen in the anterior compartment and posterior compartment of the leg.
When compartment syndrome is caused by repetitive heavy use of the muscles, as in a cyclist, it is known as chronic compartment syndrome (CCS). This is usually not an emergency, but the loss of circulation can cause temporary or permanent damage to nearby nerves and muscle.
The normal mean interstitial tissue pressure is near zero mmHg in non-contracting muscle. If this pressure becomes elevated to 30 mmHg or more, small vessels in the tissue become compressed, which leads to reduced nutrient blood flow i.e., ischemia and pain. Of particular importance is the difference between compartment pressure and diastolic blood pressure; where diastolic blood pressure exceeds compartment pressure by less than 30mmHg it is considered an emergency.
Untreated compartment syndrome mediated ischemia of the muscles and nerves lead to eventual irreversible damage and death of the tissues within the compartment.
The 6 "Ps"—pain out of proportion to what is expected, paresthesias, passive stretch pain, pulselessness, paralysis, and pressure on passive extension of the compartment—are said to be useful in recognition of compartment syndrome. Of these only the first two are reliable in the latter stages of compartment syndrome.
If you are a patient outside of hospital
Return to the emergency department immediately, or nearest hospital.
If you are a physician
Remove any cast or bandage around the limb immediately - all layers should be clear down to skin
Contact a senior orthopaedic or vascular surgeon
Subacute compartment syndrome, while not quite as much of an emergency, usually requires urgent surgical treatment similar to acute compartment syndrome.
Chronic compartment syndrome in the lower leg can be treated conservatively or surgically. Conservative treatment includes rest, anti-inflammatories, elevation of the limb and manual decompression. In cases where symptoms persist the condition should be treated by a surgical procedure, subcutaneous fasciotomy or open fasciectomy. Without treatment chronic compartment syndrome can develop into the acute syndrome. A possible complication of surgical intervention for chronic compartment syndrome can be chronic venous insufficiency.
Hyperbaric oxygen therapy has been shown to be a useful adjunctive therapy to crush injury, compartment syndrome, and other acute traumatic ischemias by improving wound healing and reducing repetitive surgery.
Creatine use may lead to exertional compartment syndrome. (Abstract & Commentary).(muscle disease)(Brief Article)
Aug 01, 2002; Synopsis: Dietary creatine supplementation significantly increases the resting and postexercise anterior compartment pressure of...