Compartment Syndrome

Compartment syndrome develops when swelling or bleeding occurs within a compartment. Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted. Without a steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.

In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and tissue death may result. This does not usually happen in chronic (exertional) compartment syndrome.

Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.

Cause

Acute Compartment Syndrome

Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.

Conditions that may bring on acute compartment syndrome include:

A fracture.
A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg with another player’s helmet.

Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.

Crush injuries.

Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.

Constricting bandages. Casts and tight bandages may lead to compartment syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.

Chronic (Exertional) Compartment Syndrome

The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.

Conditions

  • Achilles Tendon Injury
  • Adolescent Anterior Knee Pain
  • Ankle Sprains
  • Anterior Cruciate Ligament Injuries
  • Baseball Injuries
  • Basketball Injuries
  • Burners & Stingers
  • Bursitis of the Hip
  • Compartment Syndrome
  • Elbow Fractures
  • Forearm Fractures in Children
  • Fracture of the Proximal Tibia
  • Golf Injuries
  • Growth Plate Fractures
  • Hamstring Muscle Injuries
  • High School Sports Injuries
  • Hockey Injuries
  • Jumper’s Knee Injuries
  • Meniscus Tear
  • Muscle Contusion (Bruise)
  • Runner’s Knee
  • Shoulder Separation Injury
  • Skiing Injuries
  • Sledding Injuries
  • Soccer Injuries
  • Sprains, Strains & Soft Tissue Injuries
  • Stress Fractures
  • Swimming Injuries
  • Tennis Injuries
  • Throwing Injuries
  • Volleyball Injuries

Treatments

  • Achilles Tendon Repair
  • Acromioplasty
  • Ankle Fracture Repair (Ilizarov/Deformity Correction)
  • Ankle Joint Fusion(Ilizarov/Deformity Correction) Surgery
  • Anterior Cruciate Ligament Repair
  • Arthroscopic Chondroplasty
  • Arthroscopic Meniscus Repair
  • Bankart Repair
  • Biceps Tendon Rupture Surgery
  • Biceps Tenodesis
  • Broken Collarbone Surgery
  • Cartilage Transplant
  • Elbow Epicondylitis Surgery (Tenex Repair)
  • Elbow Fracture Surgery
  • Hand & Wrist Surgery
  • High Tibial Osteotomy
  • Knee Arthroscopy
  • Labrum Surgery
  • Lateral Collateral Ligament Surgery
  • Medial Collateral Ligament (MCL) Repair
  • Meniscus Repair
  • Muscle Strain Treatment
  • MPFL – Reconstruction of the Patella
  • Non-Unions of the Tibia Fractures (Ilizarov Correction Surgery)
  • OCE – Repair of the Osteochondritis
  • Overuse Injury Treatment
  • Partial Menisectomy
  • Posterior Cruciate Ligament (PCL) Repair
  • Revision Shoulder Replacement Surgery
  • Rotator Cuff Repair Surgery
  • Shoulder Arthroscopy
  • Shoulder Arthroplasty
  • Subchondroplasty
  • Shoulder Impingement Syndrome Surgery
  • Shoulder Separation Surgery
  • Taylor Spatial Frame Surgery
  • Throwing Injury Surgery

Conservative Treatments

The Orthopedic physicians at Peninsula Bone & Joint Clinic provide conservative treatment options for Sports Related conditions and injuries.

Symptoms

Acute Compartment Syndrome

The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.

  • The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.

  • There may also be tingling or burning sensations (paresthesias) in the skin.

  • The muscle may feel tight or full.

  • Numbness or paralysis are late signs of compartment syndrome.

  • They usually indicate permanent tissue injury.

  • Chronic (Exertional) Compartment Syndrome

  • Chronic compartment syndrome causes pain or cramping during exercise. This pain subsides when activity stops. It most often occurs in the leg.

 

Symptoms may also include:

  • Numbness

  • Difficulty moving the foot

  • Visible muscle bulging

Diagnosis

Physical Examination & Patient History

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

Principles of Sports Medicine

  • Timely Care

  • Minimally Invasive Procedures

  • Advanced Rehabilitation

  • Injury Prevention

One of the main goals of sports medicine is to put off major orthopedic surgery (such as joint replacement) as long as possible or even remove the need altogether with physical therapy, minimally invasive arthroscopic surgery and timely care.

When everything is working well, you hardly give them a thought. But when a problem arises, it’s often impossible to ignore.

Treatment Options

Non-Surgical

Chronic (Exertional) Compartment Syndrome

Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms.

Your symptoms may subside if you avoid the activity that caused the condition. Cross-training with low-impact activities may be an option. Some athletes have symptoms that are worse on certain surfaces (concrete vs. running track, or artficial turf vs. grass). Symptoms may be relieved by switching surfaces.

Surgical

Acute Compartment Syndrome

Acute compartment syndrome is a surgical emergency. There is no effective nonsurgical treatment.

Your doctor will make an incision and cut open the skin and fascia covering the affected compartment. This procedure is called a fasciotomy.

Sometimes, the swelling can be severe enough that the skin incision cannot be closed immediately. The incision is surgically repaired when swelling subsides. Sometimes a skin graft is used.

Chronic (Exertional) Compartment Syndrome

If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell.

Usually, the skin incision for chronic compartment syndrome is shorter than the incision for acute compartment syndrome. Also, this surgery is typically an elective procedure — not an emergency.

Conservative Treatment Options

  • Non-Operative Sports Medicine Treatment

Treatment Highlights

FastFix 360 – Meniscus Repair

Peninsula Bone & Joint Clinic

The Orthopaedic physicians at Peninsula Bone & Joint Clinic provide comprehensive services to all members of the family.
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