Acute and Chronic Compartment Syndrome
Compartment syndrome is a condition that occurs in the body in which intra-muscular pressure increases due to direct trauma or an internal response to increased activity. Although uncommon, it can become a serious problem and if left untreated life threatening. In this article I will discuss compartment syndrome of the lower leg. However, it should be noted that it could occur in the forearm and abdomen.
In order to understand what compartment syndrome is, we must first learn a little more about the anatomy of the lower leg. The muscles, arteries, veins and nerves are divided into four compartments. A thin layer of tissue called fascia surrounds each compartment. Fascia acts like a wrapping or casing that holds its contents in place. The anterior compartment holds most of the muscles that are responsible for ankle dorsiflexion (pulling the foot up) and toe extension. The lateral compartment houses the muscles that allow a person to move their foot to the outside and the tibial nerve. The tibial nerve affects the muscles on the back of the leg and the bottom of the foot. A third compartment, called the superficial posterior compartment, contains the muscles responsible for plantar flexion (pointing the foot down) and toe flexion. The last compartment is called the deep posterior compartment, which contains the posterior tibial artery and muscles responsible for toe and plantar flexion.
Acute compartment syndrome is caused by direct trauma from a fracture or direct contact from an object traveling at a high rate of speed. It can occur in any compartment and is typically in an area that is unpadded. Chronic exertional compartment syndrome is an overuse injury that usually involves the anterior and/or lateral compartments. The person typically has no symptoms at rest. It is only when the activity level is increased that one notices a discomfort in their leg. When the activity is stopped, the pain quickly disappears.
The signs and symptoms of compartment syndrome are:
• Swelling of the lower leg that
makes the skin appear tight and shinny
• Numbness and tingling of the lower leg, foot, and toes
• Pain that appears while performing a specific activity and starts
at a specific point during exercise
• Muscle weakness dorsiflexing the foot and extending the
toes
• A decrease in the dorsal pedis pulse due the constriction of the
arteries
Treatment for acute compartment syndrome should include immediate evaluation by a physician to ensure that blood flow to the muscles and nerves is not compromised. If left untreated, the increased pressure can cause muscle tissue to become deprived of oxygen resulting in death of the muscle. When this occurs, the necrotic tissue must be removed leaving the patient with limited foot movement and a lower leg deformity. Chronic compartment syndrome treatment should include rest, ice, and elevation. Compression is not advised for any type of compartment syndrome signs and symptoms because it increases the pressure being exerted on the muscles and nerves. If problems persist, surgical intervention may be recommended. Surgery typically involves small incisions that cut into the fascia of the involved compartment to release pressure that builds up during activity.
Compartment syndrome is a fairly uncommon condition, but can be menacing and a serious problem if untreated. If you have any questions contact a physician, athletic trainer, physical therapist, or other qualified health professional for advice. With the right treatment and an understanding of compartment syndrome, the symptoms can be managed so that athletic activity is enjoyable and pain free.