Compartment Syndrome

ExitCare ImageThere are 4 main compartments within the leg that are divided by thick, ligament-like tissue (fascia). The compartments contain the muscles, nerves, arteries, and veins. If swelling occurs in one of the compartments, the fascia may not stretch to accommodate for swelling. The swelling results in an increased pressure within the compartments that eventually stops blood flow in the veins and arteries. The combination of pressure and lack of blood flow damages the muscles and nerves. This condition is known as compartment syndrome. Multiple types of compartment syndrome exist including acute compartment syndrome and chronic, exertional compartment syndrome. This document is specific to acute compartment syndrome. Compartment syndrome is most commonly associated with the leg. However, compartments exist in all extremities and can also be affected.

SYMPTOMS

  • Pain in the leg at rest and with motion of the foot or toes.

  • Feelings of fullness and pressure in the leg.

  • Numbness and tingling of the leg, foot or ankle.

  • Weakness or paralysis of the muscles of the foot and ankle.

  • Cold, blue or pale foot and toes (seek medical attention immediately).

CAUSES

  • Compartment syndrome is cause by an increase in the pressure of 1 or more of the compartments in the leg. The increase in pressure may be due to an increase in the contents within the compartment. This pressure may be the result of fluid from swelling or bleeding. The pressure may also be from a decrease in volume capacity of the compartment because of a cast fitted too tightly around the leg.

RISK INCREASES WITH:

  • Trauma to the leg

  • Tight cast.

  • Medications that thin the blood (warfarin [Coumadin], aspirin, anti-inflammatory medications).

  • Bleeding disorders.

PREVENTION

Currently there is no way known to prevent compartment syndrome. Protective equipment that is fitted properly may reduce the severity of an injury. A less severe injury is less likely to cause compartment syndrome. It is also important to have a cast or splint fitted properly after an injury or surgery.

PROGNOSIS

If recognized and treated early, compartment syndrome is usually curable.

RELATED COMPLICATIONS

  • Permanent injury to muscles and nerves of the leg, foot, and ankle. The results of permanent injury to these areas include numbness, paralysis, or a nonfunctional limb.

  • Kidney failure and death from dead muscle products in the bloodstream.

TREATMENT

Treatment initially involves relieving pressure within the affected compartment. If the condition is due to a cast or splint, the cast or splint is removed. If the increased pressure is due to bleeding or swelling, surgery to cut the fascia is necessary.

Acute compartment syndrome surgery is an emergency procedure because of the risk of:

  • Kidney failure.

  • Death.

  • Damage that may be irreversible after only 8 to 12 hours.

Surgery involves cutting the fascia to relieve pressure. The incision may be left open initially because of swelling. After the tissues have healed, physical therapy is recommended to completely regain the strength and motion of the affected joints.

MEDICATION

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Contact your caregiver immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

SEEK MEDICAL CARE IF:

  • You experience pain, numbness, or coldness in the limb.

  • Blue, gray, or dark color appears in the fingernails or toenails.

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).