Compartment syndrome is a condition characterised by an increase in pressure within a limited space, this in turn compromises both the circulation and function of the tissues within that space. The space or the compartment consisting of the muscles, blood vessels, arteries and nerves is surrounded by a layer called the fascia. This fascia is a tough connective tissue, hence why it is unable to adapt to increased pressure. Compartment syndrome can be acute onset, or more chronic.
Acute compartment Syndrome:
Acute compartment syndrome is a medical emergency and often presents after a traumatic injury. The most common location for acute compartment syndrome is the anterior or front compartment of the leg that contains the tibialis anterior muscle, extensor muscles of the toes, tibial artery and peroneal nerve. Common conditions that can lead to acute compartment syndrome include:
Fractures (Tibial fractures being the most common)
Burns
Crush injuries
Vascular injuries
Thrombosis (clots)
Bleeding disorders
Casts or splints worn incorrectly
Tight bandages
Intense athletic activity
Symptoms of acute compartment syndrome:
Limb pain that is severe
Pain not reduced with medication
Pain that increases with movement of the limb
Burning or tingling
Reduced limb strength
Temperature reduction
Discolouration and swelling (whiteness/ blueness)
Reduced mobility of toes and fingers.
Treatment for acute compartment syndrome: A surgery called fasciotomy if often performed, where a cut is made in the skin down to the fascia to release the pressure inside the compartment. This cut remains open to ensure the pressure does not build up again. This surgery aims to decrease the chance of permanent damage to internal structures.
Chronic compartment syndrome:
Chronic or exertional compartment syndrome, unlike acute compartment syndrome is not an emergency. This condition develops over days or weeks and is often an outcome of intense exercise, especially intense activity that is repetitive. The pain usually disappears once the strenuous activity ends.
Symptoms of chronic compartment syndrome:
Numbness in the area
Tightness in the relevant limb
Tingling in the affected area
Weakness in the limb
Bulge in the muscles
Common causes of chronic compartment syndrome:
Enlarged muscles
Venous hypertension (increased pressure in veins)
Abnormal lack of flexibility in fascia
General treatment of chronic compartment syndrome:
Anti-inflammatory Medication
Elevation of the affected limb
Orthotic shoe inserts
Ice post exercise
How can my Physiotherapist help?
Chronic Compartment Syndrome:
Diagnosis
Adjusting load appropriately
Modifying loading biomechanics
Addressing muscles imbalances
Education on pacing activity
Acute Compartment Syndrome:
Diagnosis and acute management including specialist referral
Post surgery rehab
Preventing stiffness
Restoring normal range
Muscle training to prevent muscle atrophy
Retraining of gait if relevant
Retraining for relevant activities (e.g. sports, stairs, occupation)
Compartment syndrome may present similarly to other conditions, hence why it is important to rule out other possibilities.
Cellulitis- This condition is a bacterial infection that usually occurs when the skin that acts as a barrier to bacteria is wounded or broken. The swelling, tenderness and tightness of the skin are features that are similar between cellulitis and compartment syndrome, hence why these conditions can be mistaken for each other.
Deep Vein Thrombosis- This occurs when a blot clot forms inside a vein, interfering with normal blood flow. Swelling, pain and discoloration are cardinal signs of deep vein thrombosis, and these symptoms as mentioned earlier are also common in compartment syndrome.
Gas Gangrene- This is a life-threatening condition caused by a bacterial infection in the muscle leading to rapid tissue destruction and the production of gas. The gas build-up often results in noticeable swelling, hence why gas gangrene can also be mistaken for compartment syndrome.
Take home messages: Compartment syndrome is rare but can have severe complications if diagnosis is late or missed and treatment delayed. If you have had a recent injury and develop severe pain it is important to be seen by your healthcare practitioner as soon as possible for evaluation. If you have been having persistent chronic pain and can’t get to the bottom of its cause, see your physiotherapist for an evaluation and consider chronic compartment syndrome.
References:
McQueen, M. M., & Court-Brown, C. M. (2003). Compartment monitoring in tibial fractures. The pressure threshold for decompression. The Journal of Bone and Joint Surgery. British Volume, 85(5), 693–697. https://doi.org/10.1302/0301-620X.85B5.14352
Agency for Clinical Innovation. (2021). Acute compartment syndrome: Recognition and management of patients with musculoskeletal conditions. NSW Government. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/458188/ACI-MSK- Acute-compartment-syndrome.pdf
Kanj, W. W., & Gunderson, M. A. (2022). Acute compartment syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448124/
Orthopedic + Sports Medicine Institute of Fort Worth. (n.d.). Compartment syndrome. https://www.osmifw.com/orthopedic-diseases-disorders/compartment-syndrome/