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About Compartment Syndrome

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At UW Health in Madison, Wisconsin, our Vascular Care team provides expert treatment for compartment syndrome.

 

Compartment syndrome involves the compression of nerves and blood vessels within an enclosed space. The increased pressure within the muscles that is caused by the condition can lead to blood flow impairment and damage to the muscle and nerve.

 

What is compartment syndrome?

 

Muscle groups in arms and legs are separated by thick layers of tissue called fascia. Inside the layers of fascia is a confined spaced, called a compartment, which is home to the blood vessels, nerves and muscle tissue.

 

Because fascia do not expand, swelling in the compartment can lead to increased pressure, which compresses the nerves, blood vessels, and muscles. Blood flow to the compartment can be blocked if the pressure gets too high. This can lead to impaired function and occasionally permanent injury to the muscle and nerves. If the pressure is prolonged, there is a risk that the limb will need to be amputated.

 

Who is at risk for compartment syndrome?

 

Chronic compartment syndrome occurs in patients due to overuse injury. It is typically seen in patients with jobs that demand long periods of time on their feet, or in athletes performing repetitive high impact activity.

 

The condition often affects people in the following demographics:

  • Both male and female athletes (median age 20)
    • Elite runners
    • Athletes with high impact and endurance activities (soccer players, track and field athletes, etc.)
    • Athletes who have used anabolic steroids or creatine supplements causing the muscle to swell
  • Military personnel
  • Postal carriers
  • Fire fighters, etc.

How is compartment syndrome diagnosed?

 

Often times, a physical exam is unremarkable and does not reveal if compartment syndrome is the culprit of chronic lower leg pain. Patients with compartment syndrome exhibit a consistent, predictable and reproducible trajectory of symptoms during physical activity.

 

Once the patient begins the pain-inducing exercise they will experience:

  • An increase in intensity of pain in lower limbs as they continue to perform exercise
  • Intolerable pain after about 20 minutes causing the athlete to discontinue the activity
  • Cessation of pain and tightness shortly after activity

Diagnosis of compartment syndrome is confirmed with the measurement of pressures in the compartment by inserting a pressure-metered needle into the compartment. A resting pressure and a 5-minute post-exercise pressure measurement should be recorded. Normal compartment pressures are less than 15mmHg.

 

A positive diagnosis would be represented by:

  • A resting pressure between 15-25 mmHg
  • Post-exercise pressure > 25mmHg

Common Misdiagnoses

 

Many of the symptoms associated with chronic compartment syndrome are consistent with other ailments of the lower extremities. A definitive diagnosis could take up to two years of enduring symptoms, despite treatment attempts for differential diagnoses.

 

Common misdiagnoses include:

  • Medial tibial stress syndrome (shin splints)
  • Stress fracture
  • Deep vein thrombosis
  • Nerve entrapment
  • Vascular disorders

Options for Treating Compartment Syndrome

 

The outlook for recovery from compartment syndrome is excellent with prompt diagnosis and treatment.

 

Treatment options can vary for each individual. While a non-surgical, conservative approach could include rest, anti-inflammatory medication and physical therapy, it will likely only alleviate symptoms briefly. A surgical approach can deliver permanent relief and allow the patient to return to their desired level of physical activity.

 

With surgical treatment, small skin incisions are made and sections of the fascia are removed to release pressure. Incisions for chronic compartment syndrome are small (2 inches) and closed after fascia removal. The procedure is generally covered by insurance.

 

Post-surgery Rehabilitation Guidelines (pdf)