Compartment syndrome: Find specialists and information

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Muscles, nerves and bones are affected by accidents or injuries. One complication of these injuries is compartment syndrome. The tissue pressure increases due to bleeding and swelling. Compartment syndrome can also occur in competitive athletes without a previous accident. To ensure that the muscle tissue remains healthy and intact, compartment syndrome must be treated quickly.

Find out more about compartment syndrome, what exactly happens and how important treatment is here. You can also find selected specialists for the treatment of compartment syndrome here.

ICD codes for this diseases: T79.6

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Article overview

What is compartment syndrome?

Compartment syndrome (ICD T79.6) refers to an increase in tissue pressure in an enclosed space (compartment). A compartment is a group of muscles that are surrounded on the outside by a firm tendon-like muscle skin (fascia). The fascia that surrounds the muscles in the so-called boxes is only minimally stretchable. Therefore, swelling of the muscles, for various reasons, leads to an increase in pressure in the box, especially as the muscle skin does not stretch.

In medical terminology, these compartments are also known as muscle lodges. This is why compartment syndrome is also known as box syndrome.

Muskulatur Muskeln
Musculature of the human body © adimas / Fotolia

What can cause an increase in pressure in the compartment?

An increase in pressure in a muscle compartment can occur for various reasons:

  • Traumatic (after exposure to force)
  • due to blood circulation
    • Increased blood flow after vascular occlusion and reopening
    • Increased blood flow after temporary hypothermia
    • impaired outflow of blood due to thrombosis of the veins or
    • due to a bandage that is too tight

What happens with compartment syndrome?

Compartment syndrome causes swelling of the affected muscles, which disrupts blood circulation in the small vessels. This happens in particular because the muscle cannot expand.

The injured and swollen tissue can die, which can lead to tissue defects and tissue death (necrosis). Muscles in particular require a lot of oxygen-rich blood and nutrients, which is why they are very susceptible to tissue damage.

Nerves can also be affected by the increase in pressure. Nerve compression causes discomfort and pain.

In any case, untreated compartment syndrome can cause tissue damage or permanent muscle damage.

Where does compartment syndrome occur most frequently?

Compartment syndrome most frequently affects the ligaments of the lower leg and foot, and less frequently the forearm and hand.

Also worth mentioning is abdominal compartment syndrome, which is an increase in pressure in the abdominal cavity (abdominal). In contrast to compartment syndrome in the extremities, i.e. the arms and legs, abdominal compartment syndrome does not cause damage to the muscles, but to the abdominal organs. In particular, the small intestine is affected, which suffers tissue damage within a few hours due to swelling and insufficient blood supply.

In principle, compartment syndrome can occur anywhere where tissue is enveloped by a tight layer of connective tissue.

Kompartmentsyndrom
Compartment syndrome with bruising and nerve compression © Henrie / Fotolia

How quickly does compartment syndrome occur?

Basically, compartment syndrome can be divided into an acute and a chronic form, depending on the cause:

In acute compartment syndrome, high tissue pressure occurs suddenly, i.e. within a few hours, in the affected compartment following a traumatic injury. This trauma can be caused by

  • bruising
  • falls
  • severe bruising and
  • bone fractures

can be triggered. Also

  • bandages that are too tight
  • other types of constrictions and
  • surgical complications

can also trigger acute compartment syndrome.

The increased pressure in the compartment prevents the blood supply to the muscle and nerve function. The pressure prevents the accumulation of fluid from draining away. There is a risk of permanent damage to the muscles and nerves.

Acute compartment syndrome is always a medical emergency!

Krankenwagen im Notfall
Acute compartment syndrome is a medical emergency © Thaut Images / Fotolia

Chronic or functional compartment syndrome is caused by long-term overuse and occurs almost exclusively in the extremities.

One of the most important risk factors for this is excessive muscle training. Exercise-induced enlargement of the muscles leads to increased pressure within the muscle box, which can cause the muscles to swell during intense exertion, resulting in the blood vessels leading to and from the muscles being compressed.

This stress-induced compartment syndrome is particularly common in middle and long-distance runners (marathon and triathlon) and competitive walkers.

What are the symptoms of compartment syndrome?

Typical problems with compartment syndrome are pain and nerve loss.

Acute compartment syndrome manifests itself through

  • pronounced pain,
  • a strong feeling of tension and
  • sensory disturbances up to the
  • complete loss of feeling and mobility in the area of the

in the affected muscle area. The sometimes unbearable pain cannot be alleviated by the administration of painkillers. Similarly, elevating the leg does not improve the pain symptoms.

In addition, there is often

  • significant swelling and
  • hardening of the muscles

occur.

Due to the lack of blood supply and the damage to the nerves in the ligaments, sensory and motor deficits soon occur, for example:

Patients with chronic compartment syndrome typically feel

  • a feeling of pressure in the affected area and
  • a sharp pain that occurs during or immediately after physical activity.

Also

  • a temporary loss of strength in the legs or arms as well as
  • intermittent tingling of the skin

can also indicate a functional compartment syndrome. As a rule, taking breaks from walking or suspending training quickly alleviates the symptoms.

How is compartment syndrome diagnosed?

If acute compartment syndrome is suspected, the doctor will first carry out functional tests . This means that he checks the function of the muscles and nerves. In particular, he will examine the mobility of the affected region and the sensitivity in more detail. He also feels the pulses, which are often weakened or can no longer be felt in the case of compartment syndrome.

If a compartment syndrome is suspected during the examination, the doctor can measure the pressure in the muscle box. This involves inserting a probe into the muscle box from the outside and measuring the pressure from the outside. This is a pressure transducer that can be used to read the exact pressure in the muscle box (unit millimeter mercury column = mmHg) from the outside. Above a certain tissue pressure, it is essential to open the muscle box and relieve the muscles.

However, there is no minimum threshold value at which compartment syndrome can be ruled out. The pressure measurement is merely an aid to assessing the progression of the disease. If the examination reveals severe swelling of the muscles and the patient shows corresponding symptoms of muscle constriction and circulatory disorders, a suspected diagnosis of compartment syndrome should still be made and further measures taken.

How is compartment syndrome treated?

The treatment of acute compartment syndrome is an emergency operation. It requires immediate surgical treatment in which a so-called fasciotomy is performed. This means that the thick and firm muscle cavities (fascia) surrounding the muscle are split and opened in a long stretch.

To prevent a renewed increase in tissue pressure, the surgical wound is not immediately closed again. Instead, it remains open with tissue protection.

The wound is then dressed regularly and skin closure can be performed once the swelling has subsided. In some cases, however, a split-thickness skin graft must also be performed. This involves a skin graft taken from the same thigh and modified in a mesh-like manner using special measures.

In the case of chronic compartment syndrome, relief and cooling help in acute cases. After 48 hours, you can massage and warm the painful muscles. Heparin ointments can also be used after this two-day period.

In the long term, chronic compartment syndrome can be treated conservatively to a certain extent by means of

  • Modifications to training and/or
  • in the choice of footwear.
  • The use of drugs from the group of non-steroidal anti-inflammatory drugs can also provide short-term relief for those affected. These include ibuprofen, for example.

Competitive athletes who want or need to maintain their training level can have a surgical splitting of the muscle fascia performed.

What is the prognosis for compartment syndrome?

The duration and course of the disease depend above all on rapid treatment. In particular, rapid relief of the increased pressure in the compartment is essential. Ideally, the lack of oxygen and nutrients in the muscles (muscle ischemia) should be counteracted at an early stage. If this is achieved within a few hours, the muscles can usually recover completely.

However, if the compartment syndrome remains untreated, the muscle tissue dies due to the lack of oxygen supply. This can lead to

  • pronounced functional limitations of the muscles,
  • joint stiffness or
  • abnormal flexion of the hands and fingers.
  • If the nerves are damaged, patients also suffer from permanent signs of paralysis.
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