Compartment syndrome

Compartment syndrome is a serious medical condition in which increased pressure within a body compartment compromises blood flow and tissue function, potentially leading to permanent damage if not promptly treated. There are two types: acute and chronic. Acute compartment syndrome can lead to a loss of the affected limb due to tissue death.

Symptoms of acute compartment syndrome (ACS) include severe pain, decreased blood flow, decreased movement, numbness, and a pale limb. It is most often due to physical trauma, like a bone fracture (up to 75% of cases) or a crush injury. It can also occur after blood flow returns following a period of poor circulation. Diagnosis is clinical, based on symptoms, not a specific test. However, it may be supported by measuring the pressure inside the compartment. It is classically described by pain out of proportion to the injury, or pain with passive stretching of the muscles. Normal compartment pressure should be 12-18 mmHg; higher is abnormal and needs treatment. Treatment is urgent surgery to open the compartment. If not treated within six hours, it can cause permanent muscle or nerve damage.

Chronic compartment syndrome (CCS), or chronic exertional compartment syndrome, causes pain with exercise. The pain fades after activity stops. Other symptoms may include numbness. Symptoms usually resolve with rest. Running and biking commonly trigger CCS. This condition generally does not cause permanent damage. Similar conditions include stress fractures and tendinitis. Treatment may include physical therapy or, if that fails, surgery.

ACS occurs in about 1-10% of those with a tibial shaft fracture. It is more common in males and those under 35, due to trauma. German surgeon Richard von Volkmann first described compartment syndrome in 1881. Delayed treatment can cause pain, nerve damage, cosmetic changes, and Volkmann's contracture.