You fracture your lower leg in an accident and while recovering, you experience pain, tightness and numbness in the calf. Guess what? It’s time to go back to the emergency room. You may have a condition called Compartment Syndrome.
What Is Compartment Syndrome?
Compartment Syndrome happens when a grouping of muscles, nerves and blood vessels in the leg or arm (known as a compartment) are put under pressure by bleeding or swelling. In a limb compartment, all of the muscles, nerves and blood vessels are covered by tough membranes called fascia. Fascia are notoriously non-stretchy, so those compartments become like enclosed spaces. When bleeding or swelling happens after an injury or because of repetitive stress, this enclosed space can create too much pressure and reduce blood flow, causing nerves, muscles and blood vessels to become starved for oxygen. It can be a very dangerous condition if left untreated.
What Is the Difference Between Acute and Chronic Compartment Syndrome?
There are two types of Compartment Syndrome, with big differences between the two types. Acute Compartment Syndrome (ACS) is a sudden onset condition usually related to an injury. If left untreated, ACS can lead to muscle and nerve damage, amputation and even death. Chronic Compartment Syndrome (CCS) is a repetitive motion condition often seen in athletes. It’s less dangerous than ACS and can often be treated without surgery.
Where Does Compartment Syndrome Usually Happen?
The lower leg has four major muscle compartments and is the site of most Compartment Syndrome cases. The front calf is particularly susceptible. However, we also see this condition in the forearms, thighs, buttocks, hands and feet.
What Causes Compartment Syndrome?
A leg fracture is one of the most common causes of Acute Compartment Syndrome, according to a 2015 study in Muscle, Ligaments and Tendons Journal. Swelling or bleeding related to the break can lead to pressure build-up in the fascia putting dangerous pressure on nerves, muscles and blood vessels. ACS can also be caused by crush injuries or conditions where blood flow is blocked and then released.
On the other hand, Chronic Compartment Syndrome usually results from tissue swelling from repetitive stress or overuse. We often see this condition in runners, cyclists and swimmers. Steroid use has also been linked to CCS in some athletes.
What Are the Symptoms of Compartment Syndrome?
While some of the symptoms of acute and chronic Compartment Syndrome are similar, the most important thing to remember is that ACS happens after injury or trauma. This is usually after a break or crush injury but in rare cases can happen after a minor injury. CCS symptoms are similar but less painful and without a single traumatic injury.
Here are some key symptoms of ACS, according to the American Physical Therapy Association:
- Severe Pain
- Tingling, burning or numbness
- A feeling that the limb is tight or full
- Painful to the touch
- Inability to bear weight
CCS symptoms include:
- Pain and cramping that gets worse with activity
- Mild swelling
- Numbness or tingling
How Does My Doctor Diagnose Compartment Syndrome?
If you experience common symptoms following a fracture or injury, your doctor should check for Compartment Syndrome right away. Diagnosis of Chronic Compartment Syndrome can be more challenging since it often shares symptoms with other conditions like tendonitis. Your orthopaedist can perform a specific test called a compartment pressure measurement to check for Compartment Syndrome, and ultrasound, X-rays and MRIs are also valuable diagnostic tools.
How Can I Prevent Compartment Syndrome?
Caring for your limb following an injury is the best way to prevent ACS. If you are wearing a cast for an arm or leg injury, be sure to keep the area elevated and iced. See your doctor right away if you have concerns about pain or swelling. To prevent CCS, make sure that you are using good form in physical activities, wearing supportive footwear and changing up your workouts to avoid repetitive stress. Working with a trainer to help ensure correct form is a good practice for athletes.
What Are the Treatment Options for Compartment Syndrome?
Because of the pressure buildup and risk of nerve damage, Acute Compartment Syndrome is considered a surgical emergency, and surgery is the only treatment option. To relieve the pressure, your doctor will perform a fasciotomy, an incision in the fascia to drain the compartment. In some cases, surgery may be required for Chronic Compartment Syndrome, but physical therapy is a good approach as a first option.
How Can Physical Therapy Help With Compartment Syndrome?
Whether or not surgery is needed, physical therapy can plan an important role in recovery from Compartment Syndrome. In the case of Chronic Compartment Syndrome, a good PT program may help you avoid surgery altogether. Your physical therapist can help with:
- Range of motion exercises
- Strengthening exercises
- Manual therapy from your therapist to move and manipulate muscles and joints
- Ultrasound and cold therapy
- Education and modifications to avoid reinjury
Preventing and Treating Compartment Syndrome at Countryside Orthopaedics
At Countryside Orthopaedics, many of our patients have never heard of Compartment Syndrome, but it’s a threat we take very seriously. We monitor all of our orthopaedic patients carefully for any symptoms with a goal of preventing swelling and blood flow problems that can cause serious issues. With a few basic precautions, we can dramatically lower the risk of ACS. We also work with our many athletes to prevent and safely treat CCS with a combination of best practices and physical therapy. As always, education is one of the best ways to keep our patients safe and healthy and tackle problems before they become dangerous.