Compartment syndrome is usually spoken about in conjunction with crush injuries but it’s important to understand the many layers of compartment syndrome.
What is compartment syndrome?
Compartment syndrome is a rare condition that occurs when excessive tissue pressure builds up and exceeds a closed muscle compartment. The pressure decreases blood flow to muscle and nerves causing ischemia and can result in damage to both types of cells.
There are primary distinctions in types of compartment syndrome, acute and chronic, or exertional. Most often this syndrome is seen in legs and arms.
Within the legs, there are four compartments between the knee and ankle-anterior, lateral, superficial posterior, deep posterior. Compartment syndrome is frequently seen in the anterior compartment. It rarely occurs in the posterior compartment.There are also instances compartment syndrome is seen in the abdomen.
Acute Compartment Syndrome
Acute compartment syndrome is usually the result of an accident such as a broken arm or leg. Other causes of acute compartment syndrome may include:
- Crush injuries
- Extremely vigorous exercise
- Blood vessel surgery
- Constricting bandages
- Prolonged compression of a limb
- A blood clot in the arm or leg
- Some burns
- The use of anabolic steroids
Acute compartment syndrome may also be caused if an individual suffers an injury in surrounding soft tissue and the responding paramedic or EMT does not use to correct splinting process. The additional strain that is put in these areas can further the injury.
Acute compartment syndrome symptoms
- Deep leg or arm pain
- Greater pain than would be expected from the injury itself
- Visible bulging of the muscle
- Tingling or burning sensation
- Swelling and difficulty moving
- Discoloration
- Numbness or paralysis (this is a late sign and usually indicates permanent injury)
The only effective treatment is surgery on the fascia (fasciotomy). If the swelling is too severe, the incision may have to stay open until it subsides.
Chronic (Exertional) Compartment Syndrome
Chronic compartment syndrome is also known as exertional compartment syndrome and is typically caused by athletic exertion, specifically activities with repetitive motions like running or biking.
Chronic (Exertional) Compartment Syndrome symptoms
- Aching, tightness and cramping of the limb
- Numbness or tingling
- Weakness
- Swelling or bulging of the muscle
- Difficulty moving
Chronic compartment syndrome is not considered an emergency but, a physician should be seen as soon as possible. Treatment for this type of compartment syndrome is usually discontinuing the activity but physical therapy may be prescribed.
Abdominal Compartment Syndrome
Abdominal compartment syndrome is typically found in critically ill patients. It is typically associated with respiratory dysfunction but can be attributed to any organ dysfunction that increases pressure in the abdominal compartment.
This diagnosis can be confirmed by measuring the pressure within the compartment.
Abdominal Compartment Syndrome symptoms
- Distended or tense abdomen
- Pair or wincing when abdomen is touched
- Low or no urine output
- Low blood pressure
The first step to treatment is attempting to relieve some of the pressure and removing any dressings near the affected area.
Mechanical ventilation can assist with further reducing the pressure. However, in most abdominal compartment syndrome cases, fasciotomy surgery is necessary.
Rhabdomyolysis
Rhabdomyolysis is a syndrome that can stem from compartment syndrome. It is a very serious complication that can be life-threatening. With rhabdomyolysis, the trauma involves leakage of myoglobin into the blood plasma. An excess of myoglobin can result in renal tubular obstruction, nephrotoxicity, intrarenal vasoconstriction and acute kidney injury.
Rhabdomyolysis symptoms
The symptoms of rhabdomyolysis can vary depending upon the cause of the condition. With the presence of compartment syndrome, some of the following symptoms may be observed.
- Muscle pain
- Muscle weakness
- Dark red or brown urine
- Low or no urine output
- Fever, nausea or vomiting
Treatment of rhabdomyolysis must be obtained quickly to prevent acute renal failure. It is also crucial to take measures to correct electrolyte, acid-base and metabolic levels and focus on fluid resuscitation. Dialysis may be necessary.
