Compartment syndrome arises when there is an abnormal increase in pressure within a confined muscle area in the body. Typically, this condition is triggered by bleeding or swelling following an injury. The elevated pressure levels in compartment syndrome impede the circulation of blood, oxygen, and essential nutrients to and from the impacted tissues. This condition often necessitates urgent medical intervention, including surgery, to avert lasting damage.
Acute compartment syndrome vs. chronic compartment syndrome
Acute compartment syndrome stands as the predominant form of this condition. Approximately three-quarters of cases stem from a fractured leg or arm. Acute compartment syndrome progresses rapidly within hours or days and represents the most severe manifestation. If left unaddressed, it can lead to functional impairment or even necessitate amputation of the affected region.
Chronic compartment syndrome, on the other hand, evolves over a period of days or weeks and is also referred to as exertional compartment syndrome. It often arises from regular, vigorous physical activity such as running, swimming, or biking. Symptoms of exercise-induced compartment syndrome typically exacerbate during activities that induce swelling, like running, and subside post-exercise. Generally less severe than the acute form, it tends to constrain the duration and intensity of exercise and commonly affects the lower leg, buttock, or thighs.
What Happens in Compartment Syndrome?
Compartments are regions where groups of organs or muscles are organized, enclosed by webs of connective tissue known as fascia. Unlike muscles, fascia is resilient and doesn’t stretch significantly.
Following an injury, swelling can occur in the affected area, and blood or fluid resulting from inflammation may accumulate within the compartment, causing edema. However, the rigid nature of fascia restricts expansion to accommodate swelling or fluid buildup, leading to increased compartment pressure. Consequently, tissues inside the compartment receive inadequate blood flow, exerting pressure on nerves and muscles. This pressure can result in tissue necrosis, organ or muscle damage, loss of function, or potentially fatal consequences.
Compartments most susceptible to developing compartment syndrome include the legs, arms, forearms, thighs, feet, gluteal region, hands, and abdomen.
Compartment Syndrome Causes
Acute compartment syndrome may arise following various types of trauma, including:
- Crush injuries
- Excessive tightness of bandaging
- Prolonged compression of a limb during unconsciousness
- Surgery on blood vessels in an arm or leg
- Blood clot in a blood vessel of an arm or leg
- Severe muscle sprain or bruise
- Fractured bone (either immediately due to pressure from bleeding and edema or later, as a result of treatments like surgery or casting) Furthermore, the use of anabolic steroids can contribute to the development of compartment syndrome.
Abdominal compartment syndrome typically emerges after severe injury, surgery, or during critical illness. As abdominal compartment pressure escalates, blood flow to and from the abdominal organs diminishes, potentially causing injury or permanent damage to organs like the liver, bowels, and kidneys. Conditions associated with abdominal compartment syndrome include:
- Trauma, particularly leading to shock
- Abdominal surgery, especially liver transplant
- Sepsis (an infection causing systemic inflammation)
- Severe ascites (fluid accumulation in the abdomen) or abdominal bleeding
- Pelvic fracture
Exertional compartment syndrome can occur subsequent to:
- Highly vigorous exercise, particularly involving eccentric movements (extension under pressure)
- Vigorous eccentric abdominal exercises, such as sit-ups on a back extension machine in weight rooms.
Compartment Syndrome Symptoms
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