Compartment Syndrome: The muscle pain not to be missed!

Compartment Syndrome is a condition where excessive pressure in a muscle compartment restricts blood supply to that muscle. Muscles are surrounded by fascial connective tissue, which has very poor elasticity. Excessive swelling in the fascial compartment results in compression of blood vessels, then resulting in a reduction of oxygen to that muscle.

Causes

Compartment Syndrome can occur acutely after a traumatic injury (eg fracture, contusion or surgery), or as the result of a blood clot. This is caused by ongoing swelling or bleeding entrapped in the muscle’s fascial casing, increasing pressure within the muscle compartment.

Occasionally compartment syndrome can have no apparent cause, and develops over weeks or months, triggered by vigorous exercise such as running or cycling. Symptoms of chronic compartment syndrome typically worsen throughout exercise and ease with rest.

 

Signs and Symptoms:

-       Severe pain in the muscle

-       Swelling or tightness

-       Pale or waxy appearance of the skin (due to restricted blood supply)

-       Pins and needles, burning or numbness

 

What do I do if I suspect compartment syndrome?

Get assessed as soon as possible by your physio or GP, particularly if you have a history of trauma to the area. Through careful assessment, your health professional will determine if compartment syndrome is likely, and will refer you on as necessary.

Acute compartment syndrome is considered a medical emergency and can be life threatening if not addressed promptly. Insufficient blood supply over a long period of time means the area is deprived of oxygen and can result in tissue and nerve necrosis (death).

Chronic compartment syndrome can be harder to diagnose, due to transient symptoms that ease with rest. A measurement of intracompartmental pressure can be used to determine the severity of swelling in the fascial compartment. A pressure higher than 30mmHg indicates excessive pressure in the compartment. A CT or MRI scan may be recommended to rule out other serious pathologies.

 

Treatment Options

Acute compartment syndrome is a medical emergency and a fasciotomy of the affected compartment must be performed immediately to prevent permanent tissue damage. This involves cutting the encasing fascia of the muscle to release pressure, decompress the blood vessels and restore blood flow to the area.

In chronic compartment syndrome, it is recommended trying conservative rehabilitation, firstly by reducing or ceasing physical exercise/activities that exacerbate symptoms. From there, a physiotherapist can assess your strength and biomechanics, to identify any factors that may influence the condition. A referral to a sports doctor may be appropriate to discuss medication options. If conservative rehabilitation fails, or if an individual would like to continue their sport at the same level of intensity, fasciotomy surgery needs to be considered.