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
- Burns
- 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
- Burns
- 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.
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Compartment Syndrome Symptoms
Acute compartment syndrome typically manifests over several hours following a significant injury to an arm or leg. Key symptoms of acute compartment syndrome encompass:
- Persistent deep ache in the affected arm or leg
- Pain intensity surpassing expectations considering the injury’s severity
- Sensations of numbness, tingling, or electric-like pain in the limb
- Swelling, tightness, and bruising
- Weakness or loss of sensation
- Pain persists despite treatments like pain medication or elevation of the limb
- Pallor in the affected skin area
Chronic compartment syndrome, also known as exertional compartment syndrome, is characterized by aching or cramping in the affected muscle (commonly the buttock, thigh, or lower leg) that exacerbates within 30 minutes of commencing exercise. In the case of leg involvement, it may lead to foot drop, characterized by difficulty lifting the front of the foot while walking, often resulting in foot dragging. Symptoms typically alleviate with rest, and muscle function remains unaffected. Exertional compartment syndrome can mimic shin splints and may be mistaken for that condition.
Abdominal compartment syndrome generally develops in hospitalized individuals who are critically ill and on life support. Due to their condition, they may not be able to articulate their symptoms. However, doctors or family members might observe the following signs:
- Tense, distended abdomen
- Flinching or discomfort upon abdominal palpation
- Decreased or absent urine output
- Low blood pressure
Compartment Syndrome Treatments
Treatment for compartment syndrome primarily revolves around alleviating dangerous pressure within the affected body compartment. Removal of constricting dressings, casts, or splints on the affected body part is imperative.
For individuals with acute compartment syndrome, immediate surgical intervention is typically necessary to alleviate compartment pressure. Surgeons perform fasciotomy, making longitudinal incisions through the skin and underlying fascia layer to release excessive pressure.
Additional supportive measures may include:
- Positioning the affected body part below the heart level to enhance blood flow into the compartment
- Administering oxygen through the nose or mouth
- Providing intravenous fluids
- Prescribing pain medications
Chronic compartment syndrome management often involves avoiding activities that trigger symptoms. Treatment options may include:
- Incorporating stretching exercises
- Undergoing physical therapy
- Using anti-inflammatory medications
- Utilizing orthotics
- Transitioning to lower-impact exercises, like walking instead of running
- Temporarily modifying the exercise regimen to alleviate inflammation in affected muscles
Surgery is typically less urgent for chronic or exertional compartment syndrome and may be unnecessary. However, if alternative treatments fail to alleviate symptoms, surgical intervention to alleviate pressure may be warranted.
For abdominal compartment syndrome, treatment options encompass decompression of the affected area and drainage via a small tube inserted into the stomach. Additionally, healthcare providers may employ life support measures such as mechanical ventilation, vasopressor medications to support blood pressure, and kidney replacement therapies like dialysis. Surgery to open the abdomen and reduce compartment syndrome pressures may be necessary. The optimal timing for surgery in individuals with abdominal compartment syndrome is often uncertain. While surgery can be lifesaving, it may also pose risks, including:
- Increased organ damage
- Infection
- Fistula formation, wherein two body parts form unintended connections (e.g., stomach and skin surface)
- Hernia, characterized by a muscle bulging through surrounding tissue
Conclusion
Compartment syndrome presents a serious medical condition characterized by dangerous pressure buildup within enclosed muscle spaces or body compartments. Prompt recognition and appropriate treatment are essential to prevent irreversible tissue damage and potential life-threatening complications.
For acute compartment syndrome, immediate surgical intervention, often in the form of fasciotomy, is necessary to alleviate pressure and restore adequate blood flow to affected tissues. Conversely, chronic compartment syndrome may require a combination of conservative measures such as activity modification, physical therapy, and medication.
Abdominal compartment syndrome poses unique challenges, typically arising in critically ill patients. Treatment strategies involve a multidisciplinary approach, including surgical decompression, supportive therapies, and meticulous monitoring for complications.
While surgical intervention may be lifesaving, it carries inherent risks and necessitates careful consideration of timing and potential outcomes.
Overall, early recognition, appropriate management, and interdisciplinary collaboration are paramount in mitigating the adverse effects of compartment syndrome and optimizing patient outcomes.
