15315 Compartment Syndrome

Overview

Compartment syndrome happens when pressure builds up inside a closed space in your body (called a compartment) — usually in the arm, leg, hand, or foot. This pressure can reduce blood flow, which can damage muscles and nerves. It can happen suddenly after an injury (acute) or it can build up slowly during exercise (chronic).

Acute compartment syndrome is rare. Chronic compartment syndrome is uncommon, but it is seen more often in athletes and military recruits.

Anyone can get compartment syndrome, but it is most common after high-energy leg or arm injuries in people under 35. Chronic compartment syndrome mostly affects young athletes who do repetitive activities, like running, swimming, or cycling.

Symptoms

Common symptoms

• Deep, aching pain that is much worse than expected for the injury
• Pain that gets worse when you gently stretch the muscle
• A tight, swollen, or hard feeling in the limb
• Numbness, tingling, or a pins-and-needles feeling

Symptoms in children

• A child may cry more than usual, say the pain is getting worse, or refuse to move the injured limb
• Children may not be able to describe numbness, so watch for increased distress when the area is touched
• Check for increased pain when the toes or fingers are moved gently

Symptoms in older adults

• Older adults may have less obvious swelling and less elastic skin, which can make the warning signs easier to miss
• Broken bones or a fall that causes bruising can trigger compartment syndrome, so watch for new or worsening pain
• Diabetes and blood vessel problems can raise the risk, so older adults should seek help early with leg or arm pain after an injury

Causes

Main causes

• Fracture (broken bone), most often in the lower leg or forearm
• Severe crush injury to a limb
• A cast or bandage that is too tight, sealing off the blood supply
• Gunshot wounds or severe burns (less common)

Risk factors

• High-impact accidents or falls
• Heavy physical training or endurance sports, which can cause chronic compartment syndrome
• Taking blood-thinning medicines, which increase the risk of bleeding into a compartment — speak to your doctor if you are on one
• Having a family history of chronic compartment syndrome

When to see a doctor

See a doctor urgently if:

• Severe pain or worsening pain in a limb after an injury
• Numbness, weakness, or a cold/pale limb
• Inability to wiggle your toes or fingers

Book a routine appointment if:

• Recurring pain or heaviness in your legs only during exercise, which settles with rest
• Tightness or cramping in the lower leg during running, cycling, or swimming
• Concern that a previous compartment syndrome has not fully healed

Diagnosis

A doctor will ask about your symptoms, check your limb, and measure the pressure inside the affected compartment. Measuring the pressure is quick and done with a needle and a pressure monitor, usually in the emergency department or doctor's office.

Tests that may be done

• Physical examination and a review of your symptoms
• Compartment pressure measurement (called a compartment pressure test)
• In some cases, imaging such as an ultrasound or MRI for chronic symptoms

What to expect at your appointment

If acute compartment syndrome is suspected, the doctor will act fast. You may be given oxygen and fluids, and an emergency surgeon will be called. For chronic compartment syndrome, you may be referred to a sports medicine doctor or physiotherapist. Either way, the team will keep you informed and explain what they are doing.

Treatment

Treatment depends on whether the compartment syndrome is acute or chronic. Acute compartment syndrome is treated as a surgical emergency — a surgeon cuts open the tough layer around the muscle (a fasciotomy) to release pressure and restore blood flow. Chronic compartment syndrome is usually managed with rest, activity changes, and physiotherapy.

Self-care at home

• For chronic symptoms, rest from the activity that brings the pain on
• Apply an ice pack wrapped in a cloth for 15–20 minutes after exercise
• Gently stretch the muscles before and after activity
• Elevate the limb if it is swollen (only if it does not increase pain)

Medical treatments

Your doctor may recommend physiotherapy, orthotics (special shoe inserts), or activity modification to reduce pressure on the muscles. For chronic compartment syndrome, if other approaches do not help, a surgeon may discuss releasing the compartment as a planned (non-emergency) procedure. Always speak to a qualified healthcare provider about what is best for you.

When is surgery considered?

Emergency fasciotomy is needed for acute compartment syndrome. The surgeon makes an opening in the skin and the tough layer around the muscle so the pressure can go down. The opening is usually closed a few days later. In chronic compartment syndrome, surgery is only considered if symptoms keep coming back despite rest and therapy.

Living with this condition

If you have had surgery, you will need time to let the wound heal and to build back strength with physiotherapy. If you have chronic compartment syndrome, you may need to change how you exercise — for example, doing lower-impact activities or taking more rest days. You can live a full, active life by learning what works for your body.

Lifestyle tips

• Warm up properly and cool down after exercise
• Wear well-fitted shoes and sports equipment
• Take regular breaks during long training sessions
• Follow your doctor's advice about wound care after surgery

Diet and exercise

Eating a balanced diet helps your body heal and recover. Gentle exercise, such as walking or swimming, can be restarted once your doctor or physiotherapist gives you the go-ahead. Drink enough water before and after exercise, and stop if you feel sharp or unusual pain.

Mental health and emotional wellbeing

Living with pain or recovering from surgery can be stressful. It is normal to feel anxious, frustrated, or low. Talk to your doctor if these feelings continue — they can point you to support services.

Prevention

Acute compartment syndrome is difficult to prevent because it usually follows a severe injury. Chronic compartment syndrome can be lessened by gradual training, proper footwear, and stretching. If you have a cast or bandage, make sure people tell you what signs to watch for. Never ignore new tightness or pain under a cast.

Vaccines

There is no vaccine for compartment syndrome.

Screening programmes

There is no routine screening test for compartment syndrome.

Complications

If left untreated

• Permanent muscle damage and muscle death
• Nerve damage causing lasting numbness, weakness, or a foot drop (inability to lift the front of the foot)
• Severe complications such as kidney damage in very advanced cases
• In the worst cases, loss of the limb (amputation)

Long-term outlook

The outlook is very good if acute compartment syndrome is treated right away. Most people regain full use of the limb after surgery and physiotherapy. Chronic compartment syndrome can often be managed so you can keep doing the sports you enjoy.

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