Compartment syndrome occurs due to increased pressure within an enclosed space or compartment in the body. It can occur in the hand, forearm, upper arm, buttocks, leg, foot and abdomen. Compartment syndrome occurs most commonly in the leg below the knee. If left untreated, it can affect the blood supply to the muscles in the affected compartment and can result in necrosis (death) of the muscles. A rapid diagnosis and treatment to relieve pressure can lead to complete recovery of the affected muscles.

On this page

• What is compartment syndrome?
• What causes compartment syndrome?
• What damage can cause compartment syndrome?
• How common is compartment syndrome?
• What are the symptoms of compartment syndrome?
• How is compartment syndrome diagnosed?
• What is the treatment for compartment syndrome?
• What are the complications of compartment syndrome?
• What is the prognosis (outlook) for compartment syndrome?
• A note on chronic compartment syndrome
• Final Message
• References

What is compartment syndrome?

Compartment syndrome can occur if there is increased pressure within a confined space in the body. It usually occurs in areas of the body known as fascial compartments. Fascial compartments are located around the muscles. The fascial compartment is a special fabric that forms a layer around the muscle membrane. Compartment syndrome can occur in the hand, forearm, upper arm, buttocks, leg and foot. There are four fascial compartments in the leg below the knee. Compartment syndrome occurs most commonly affects the anterior (front) fascial compartment below the knee.

Abdominal compartment syndrome may also occur. It's a little different compartment syndrome affecting the extremities. This occurs when there is an increase of pressure within the abdominal cavity. It tends to affect people who are critically ill due to injury in his abdomen, bleeding into your abdomen, or have other abdominal problems such as pancreatitis (inflammation of the pancreas gland). This booklet focuses on compartment syndrome that can affect the limbs and does not address the posterior abdominal compartment syndrome.

What causes compartment syndrome?

Generally, an injury that causes an extremity compartment syndrome, and this may be almost any lesion. It can even occur after vigorous exercise. Compartment syndrome usually comes in quite quickly after injury (in 48 hours). However, a chronic (long) Compartment syndrome is also possible (see below).

The initial injury often causes swelling of muscles and tissue within the fascial compartment of the member. This causes the pressure within the compartment to rise. As time passes, and as the degree of pressure in the fascial compartment increases the flow of blood to the muscles of the compartment decreases. This lack of blood flow (called ischemia) means that oxygen is not delivered effectively to the muscles and muscle damage begins to occur. As muscle damage occurs, muscle cells begin to produce chemicals that can further increase swelling, and the pressure inside the compartment. A vicious cycle can be set. Nerves inside the compartment can also be compressed and damaged. If left untreated, the muscle can be permanently and irreversibly damaged and may die (called necrosis muscular).

What damage can cause compartment syndrome?

A fracture (broken bone) is probably the most common injury that can lead to compartment syndrome – usually a broken arm or leg. Compartment syndrome can also occur due to:

• Vigorous exercise
• Penetrating injury, stabbing or gunshot wounds.
• Crush injury.
• Burns.
• Snake bites.
• The bleeding from an injured blood vessel.
• Plaster molds are installed too tightly.
• Intravenous (usually given through a drip into a vein) that inadvertently seep inside the arm around the vein.

How common is compartment syndrome?

Compartment syndrome does not occur after every injury in the arm or leg. You are at greater risk of compartment syndrome if you have a fracture (broken bone) in the forearm (the arm below the elbow) or leg below the knee. This risk is further increased if you need an operation to repair the broken bone or if you have an infection in the affected limb. Compartment syndrome is also more likely to develop after an injury if you are taking anticoagulants (medicines to treat or prevent blood clots).

What are the symptoms of compartment syndrome?

The main symptom of compartment syndrome is pain. The pain usually occurs even at rest and may be worse on movement. The pain is likely to occur after an injury, but compartment syndrome, the pain tends to be severe and disproportionate to the injury. For example, the pain usually improves when a fracture (broken bone) is immobilized in a cast or splint. In compartment syndrome, pain typically increases despite immobilizing a fracture. Nerve damage due to compartment syndrome can also make the pain worse. You may feel a burning sensation or a tightness around the affected area.

Pins and needles can also occur in the arm or leg affected by compartment syndrome and you may have decreased sensation when the skin of the affected limb is touched. An affected limb can also be pale, will feel cold and may feel tense or hard. As the compartment syndrome progresses, you may experience loss of strength in the affected arm or leg and sometimes paralysis of the affected limb may occur.

How is compartment syndrome diagnosed?

Early compartment syndrome can be difficult for your doctor to diagnose. Compartment syndrome is often suspected by your doctor if you have had a recent injury of one of its members and has the typical symptoms.

Your doctor may want to examine the affected limb for signs of nerve damage and muscle. A specialist can also use one of the special devices that are available to measure the pressure within the fascial compartment. One such device consists of a needle placed in the fascial compartment for measuring pressure. Sometimes, an MRI may be used to aid in the diagnosis of compartment syndrome.

What is the treatment for compartment syndrome?

Compartment syndrome should be treated as soon as possible to try and reduce the chance of permanent nerve and muscle damage. You may be given oxygen using a face mask, as this can help increase the oxygen supply to the affected muscles. You can also give a bit of fluid in his veins, with a drip.

The goal of treatment for compartment syndrome is to relieve pressure within the fascial compartment surrounding muscles. This is done by performing an operation called fasciotomy. In fasciotomy, skin and fascial compartment are cut so that the pressure chamber is relieved. Any dead muscle is removed simultaneously. The wound is usually left open because, if closed, the pressure would be likely to build up again. The wound may be closed with stitches a few days later. Sometimes you use a skin graft to close the wound or wound is not closed and allowed to heal itself.

What are the complications of compartment syndrome?

Possible complications of compartment syndrome include:

• Permanent nerve damage.
• Permanent muscle damage and reduced function of the affected limb.
• Permanent scarring from the procedure of the affected extremity fasciotomy.
• In rare cases, the loss of the affected limb.
• Infection.
• Renal impairment as muscle dies, various chemicals are released by muscle, which can damage the kidneys.
• In rare cases, death can occur.

What is the prognosis (outlook) for compartment syndrome?

This depends on how fast the compartment syndrome is diagnosed and treated. Full recovery of the nerves and muscles is possible if compartment syndrome is treated quickly. Early treatment means that the blood supply to the muscles can be restored before permanent damage. Some experts say the needs compartment syndrome in the arm or leg to be treated within as little as six hours to prevent muscle necrosis (death).

A note on chronic compartment syndrome

Chronic compartment syndrome below the knee is sometimes confused with leg cramps. See separate leaflet called 'Shin splints (medial tibial stress syndrome) "for details.

Chronic compartment syndrome below the knee usually affects the anterior fascial compartment (see above) and is caused by an inflammation of one of the lower leg muscles, called the tibialis anterior muscle. The swell muscle during exercise. It usually affects runners and trail runners. It tends to cause shin splints in the lateral (outside). (Shin splints usually causes pain in the medial (inside).) In the shin pain is relieved by rest, but compartment syndrome can return each time it runs. Sometimes surgery is needed to open the compartment fascia around the muscle, to relieve the pressure.

Final Message

If you have pain, numbness, burning or weakness in a limb after a recent injury or strenuous exercise, you should immediately go to your local accident and emergency department.