6 things to know about compartment syndrome

Compartment syndrome may be rare, but it's important to recognize.

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 two primary distinctions in types of compartment syndrome, acute or chronic, and exertional. Both variations are most frequently seen in legs and arms. Here are a few other interesting facts about compartment syndrome.

1. Incorrect splinting can lead to compartment syndrome
After a trauma has been suffered, if the responding EMT or paramedic does not use the correct splinting process, it can put additional strain on the area and actually contribute to compartment syndrome. Splints should stabilize the injury but not add additional pressure in a manner that would lead to compartment syndrome. The splints should also be rechecked and adjusted regularly to account for any swelling that may develop after the trauma.

2. Anabolic steroids and anticoagulants can be a risk factor in developing compartment syndrome
With anticoagulants, bleeding after trauma cannot clot normally which can contribute to a build-up of pressure which may lead to compartment syndrome. The use of anabolic steroids also increases the risk of developing compartment syndrome as it leads to rapid growth of muscle tissue in a less elastic fascial sheath, which then contributes to increased pressure. This is especially important since athletes are the highest population to suffer from compartment syndrome. They are also a group higher in likelihood to take steroids for performance enhancement. Anterior compartment syndrome is usually the culprit for athletes. 

Acute compartment syndrome with blister formation (Photo/Wikimedia Commons)
Acute compartment syndrome with blister formation (Photo/Wikimedia Commons)

3. Compartment syndrome can be a complication of rhabdomyolysis
Individuals with rhabdomyolysis can also develop compartment syndrome. With rhabdomyolysis, the trauma or injury typically involves leakage of myoglobin (a myocyte compound that is toxic) into the blood plasma. An excess of this compound can result in renal tubular obstruction, nephrotoxicity, intrarenal vasoconstriction and acute kidney injury. Treatment should be obtained quickly in order to prevent acute renal failure.

4. Acute compartment syndrome is a medical emergency; chronic compartment syndrome is not
Acute compartment syndrome is more common than chronic and is typically the result of a fractured limb. The only effective treatment for acute compartment syndrome is a surgical fasciotomy, and individuals with this condition should go to the emergency room as soon as possible. Chronic compartment syndrome is usually caused by athletic exertion. While it is not a medical emergency, a physician should be consulted as soon as possible. Treatment for it may end up being surgical as well, but the first steps are to try discontinuing the exercise and/or physical therapy. When these measures fail, surgery becomes necessary.

5. Compartment syndrome can be present in the abdomen as well
Compartment syndrome is typically thought of as something that affects the limbs, especially the legs. However, it can also develop in the abdomen when an organ experiences severe dysfunction or failure. It is most commonly seen in critically ill patients or those who suffer respiratory problems. To confirm this diagnosis, the pressure in the abdominal cavity must be confirmed. Treatment would include the removal of anything restrictive to relieve pressure, mechanical ventilation, blood pressure medications and kidney therapies. If these fail, fasciotomy surgery is necessary.

6. Symptoms of acute, chronic and abdominal compartment syndrome are different
The symptoms of acute and chronic compartment syndrome are similar, with only a few differences. Abdominal compartment syndrome symptoms, however, are very different.

  • Chronic Compartment Syndrome symptoms – aching, tightening and cramping of the limb, numbness or tingling, weakness, swelling or bulging of the muscle and difficulty moving.
  • Acute Compartment Syndrome symptoms – similar to the symptoms of chronic compartment syndrome, but will also have a greater degree or pain, possible burning sensation, and discoloration.
  • Abdominal Compartment Syndrome symptoms – distended or tense abdomen, pain or wincing when abdomen is touched, low or no urine output, low blood pressure.

No matter which type an individual may be suffering from, compartment syndrome is a very severe medical issue and emergency treatment should be sought immediately for acute and abdominal. With chronic compartment syndrome, a physician should be consulted immediately.

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