Compartment Syndrome , or elevated muscle compartment pressure , is a condition in which dangerous levels of pressure build up in the muscle compartment due to the fascia not expanding as a result of swelling within the muscle compartment. This is most commonly found in the legs, arms, and abdomen, and can cause symptoms such as pain, swelling, or burning. In addition, the elevated pressure can block the delivery of oxygen, nutrients, and blood to the muscle compartment, which can lead to cell death and local ischemia.
The types of Compartment Syndrome are as follows:
Acute Compartment Syndrome , or sudden hypertension, is the most common type. It occurs within hours or days after a patient has sustained a serious injury, such as a broken arm or leg.
Chronic Compartment Syndrome , or chronically high pressure in muscle compartments, is usually not dangerous. It often occurs in the buttocks, thighs, lower legs, and especially the shins. The intensity and frequency of exercise are other factors that increase the risk of developing this condition. This type of compartment syndrome can occur in people of all ages, but is more common in people under 40 years of age.
Abdominal Compartment Syndrome , or high pressure in the abdominal muscle compartment, often occurs in critically ill patients who are hospitalized for a long time.
Symptoms of increased compartment syndrome
High pressure within the muscle compartment can cause pain, cramps , or numbness . Symptoms vary in severity depending on the type of compartment syndrome:
Acute Compartment Syndrome typically causes pain that is aggravated by use or stretching of the injured muscle. Patients may also experience:
- Difficulty in moving
- Muscle swelling and bruising
- It is a tingling sensation or a feeling like needles are pricking you.
- Feeling tight and burning pain in the skin area
- Severe pain or a feeling that the pain is more severe than the apparent or expected injury.
- Numbness or paralysisin that area, both of which can be signs of permanent injury.
However, if Acute Compartment Syndrome is left untreated or treated late, it can cause permanent injury and may require amputation of the affected area due to tissue death.
Chronic (Exertional) Compartment Syndrome may have symptoms such as difficulty moving due to injury, noticeable muscle swelling, numbness, and pain or cramps during exercise, etc. The pain will decrease when you stop moving or stop exercising.
Abdominal compartment syndrome often results in symptoms such as abdominal distension or swelling when the abdomen is pressed or weighted on, the patient will show pain through facial expressions or flinch, low blood pressure , and may experience decreased or no urination.
In addition, if the pressure in the abdominal muscle space increases to the point where it blocks blood flow, it can cause permanent injury to the intestines, kidneys, liver, and other organs in the abdominal cavity.
Causes of increased intra-abdominal pressure
Compartment Syndrome is caused by injury that causes bleeding or fluid from inflammation to accumulate within the muscle compartment, causing internal pressure along with the fascia not expanding. The accumulated pressure in large quantities will reduce blood flow to the muscle compartment until it is blocked, causing the surrounding muscles and nerves to be damaged due to not receiving enough nutrients and oxygen. In addition, external causes that cause Compartment Syndrome can be divided according to the type of symptoms as follows:
Acute Compartment Syndrome often occurs after a severe injury or other causes, such as:
- Use of alcohol or drugs
- The use of anabolic steroids, which are commonly used to build muscle
- Caused by burns
- Injured by force or impact
- Severe muscle bruising
- Strenuous exercise, including lifting, which places pressure on the organs.
- Bandaging or splinting that is too tight
- Broken bones
- Treating a broken bone by using a splint that is too small or too tight can cause symptoms.
- Severe sprain
- The arms and legs are compressed for a long time while unconscious.
- Vascular surgery of the legs or arms
Chronic (Exertional) Compartment Syndrome is often caused by exercise, especially in vigorous sports or sports that involve repetitive and continuous movements, such as running, cycling, and swimming.
Abdominal Compartment Syndrome is most often caused by severe injury or when the patient is in critical condition and unconscious, and may have other causes, such as:
- Burns
- Pelvic fracture
- Abdominal surgery, especially kidney transplantation
- Severe ascitesor bleeding in the abdominal cavity
- Bloodstream infection
- Exercising too hard on the abdominal area
Diagnosis of elevated compartment syndrome
Initially, the doctor will ask about the symptoms and examine the patient in the area where the symptoms occur , such as muscle tension, pain when pressing on the muscles during normal times and after exercise, and squeezing the injured area to assess the level of pain. If the doctor suspects that the patient has compartment syndrome, the doctor will measure the pressure level in the muscle compartment by using a pressure gauge to puncture the area where the symptoms occur during exercise, which may cause pain in the area being examined. The results will be measured again after exercise . The doctor may also take an X-ray to help diagnose this condition differently from other health problems that may have similar symptoms.
Additionally, if a patient has high blood pressure and other symptoms of abdominal compartment syndrome, the doctor may check by inserting a tube into the bladder to measure the pressure.
Treatment of elevated compartment syndrome
The methods used to treat Compartment Syndrome may vary depending on the type of symptoms, but all have the same goal of reducing pressure in the muscle compartment. If a cast or bandage is used, it should be removed or loosened to reduce pressure on the affected area. Each type has different methods and treatment formats, as follows:
Acute compartment syndrome requires prompt surgical removal of the fascia to relieve pressure within the muscle compartment and reduce the risk of permanent injury or tissue death that would lead to amputation. If the pressure within the muscle compartment is very high, the surgeon may wait for the swelling to subside before closing it. In some cases, skin grafts may be required in the surgical area.
In addition, additional supportive treatment may be provided, such as placing the injured organ below the heart to increase blood flow, giving oxygen, giving intravenous fluids to maintain body balance, and taking painkillers to reduce symptoms, etc.
In this chronic stage, there is no need for emergency surgery because the pressure will gradually decrease on its own after stopping exercise or reducing exertion. Chronic Compartment Syndrome is treated as follows:
- Apply cold compresses after exercise.
- Use shoes specifically designed for athletes.
- Do physical therapy
- Change your exercise style to Cross-Training or mixed exercise to create balance for your body and choose activities that do not use a lot of energy.
- Change the surface you exercise on. Some people experience symptoms on different surfaces. If you experience symptoms on concrete, try running on a track, grass, or artificial turf instead.
- Surgery: When other treatments have failed, your doctor may perform surgery to reduce pressure within the muscle compartment.
Abdominal Compartment Syndrome has the following treatment methods:
- Using a ventilatorto increase oxygen in the body
- Use of medications to control blood pressure
- Kidney Dialysis
- In some cases, abdominal surgery may be required to relieve pressure, which can lead to complications.
Complications of increased compartment syndrome
In addition to symptoms resulting from injury such as pain, swelling, numbness or burning, Compartment Syndrome can cause serious complications because the components within the muscle compartment are deprived of blood, oxygen and nutrients. If Acute Compartment Syndrome is left untreated, it can cause the following complications:
- Muscle sores, pulling , and loss of function in the arms or legs.
- Nerves are permanently damaged, causing numbness and weakness.
- Infection occurs
- Muscle breakdown
- Organs may need to be amputated due to localized tissue necrosis.
These complications can also occur with Chronic Compartment Syndrome, but are less common.
Prevention of increased intrathecal pressure
There is no definite way to prevent Compartment Syndrome. However, if symptoms occur, you should see a doctor immediately for diagnosis and treatment. In particular, Acute Compartment Syndrome, which can cause severe complications if left untreated, should also avoid alcohol, drugs, and anabolic steroids, which can cause the condition. In addition, patients who are treated with a cast or bandage, if they experience pain and swelling of the skin under the cast after taking medication, should also see a doctor.
For Chronic Compartment Syndrome, gradually building flexibility and endurance, as well as wearing appropriate footwear for exercise or sports, may help reduce the severity or prevent the condition from occurring.
