Generality
The compartment syndrome is a "disease of some clinical importance, which appears as a result of hemorrhages or edema and is characterized by an increase in pressure inside a so-called muscular compartment."
Some of the main symptoms of compartment syndrome are: pain, tingling, muscle cramps, muscle tension and a sense of numbness.
The treatment varies according to the type of compartment syndrome: in the presence of the acute form, it is necessary to intervene surgically; in the presence of the chronic form, however, it is still possible to resort to conservative therapies.
What is compartment syndrome?
The compartment syndrome is a very serious condition, the presence of which is characterized by an increase in pressure inside a so-called muscular compartment.
In anatomy, the muscle groups of the lower limbs and upper limbs are called muscle compartments, enclosed, together with the blood vessels and neighboring nerves, by a strong tissue membrane, known simply as fascia. The bands that make up the muscle compartments are not very elastic and this represents an obstacle to the expansion of the same muscle compartments.
Causes
The compartment syndrome arises as a result of hemorrhages or edema, which take place inside a muscle compartment.
The occurrence of a hemorrhage or edema in a compartment produces an abnormal increase in the pressure inside the compartment itself, as the fascia does not allow it to expand.
The aforementioned increase in blood pressure compresses the blood vessels of the affected compartment and this affects the normal flow of blood. If left untreated, impaired blood flow causes permanent damage to the muscle and nerve structures of the affected compartment.
In fact, as is known to most people, blood contains the oxygen that the tissues and organs of the human body need to survive and function at their best. Without the right blood supply, tissues and organs slowly undergo necrosis.
Necrosis of a tissue or organ means their death.
In the case of compartment syndrome, necrosis of the anatomical structures of a muscle compartment may require amputation of the affected limb.
The areas of the body most prone to compartment syndrome are: the hands, feet, thighs and arms.
TYPES OF COMPARTMENTAL SYNDROME
Doctors have distinguished compartment syndrome into two main types: acute compartment syndrome and chronic compartment syndrome.
Acute compartment syndrome is distinguished from chronic compartment syndrome by its triggering causes and by the speed of onset of symptoms.
ACUTE COMPARTIMENTAL SYNDROME
Acute compartment syndrome is the most common type of compartment syndrome.
Possible causes of acute compartment syndrome include:
- Fractures in the limbs;
- Trauma / crush injuries affecting the limbs;
- Strong trauma to the muscles, which can lead to injury (muscle tear). Severe muscle injuries can cause more or less conspicuous bleeding;
- The application of a plaster cast or a very tight bandage, when an edema is forming. In these situations, the plaster cast or the very tight bandage acts as a fascia of the muscular compartment;
- Severe burns to the limbs;
- Surgical operations aimed at repairing the blood vessels of the lower or upper limbs. In such circumstances, acute compartment syndrome represents a complication of the surgical procedure;
- Vigorous physical exertion, especially those involving eccentric movement of the muscles;
- The abuse of alcohol or certain pharmacological substances.
Acute compartment syndrome appears suddenly (takes a few hours) and, from a clinical point of view, represents a "medical emergency that requires immediate intervention.
CHRONIC COMPARTMENTAL SYNDROME
Chronic compartment syndrome is a condition that arises gradually, almost always as a result of a physical activity or a motor gesture repeated a large number of times, over a long period of time.
From a clinical point of view, it is a less serious problem than acute compartment syndrome and affects, above all, people who regularly practice sports such as running, cycling or swimming.
EPIDEMIOLOGY
Acute compartment syndrome can affect people of any age.
Chronic compartment syndrome, on the other hand, particularly affects adults under the age of 40, although - it should be noted - it can potentially arise at any age.
Symptoms and Complications
For further information: Compartment Syndrome Symptoms
The symptoms of acute compartment syndrome are different from the symptoms of chronic compartment syndrome.
The typical symptom picture of the acute form includes:
- Intense pain in the muscles of the affected muscle compartment. Very often, this pain worsens when the patient tends to lengthen it. Furthermore, it does not improve either with the elevation of the limb to which the muscle or muscles belong, nor with the intake of painkillers;
- Sense of tension in the muscles of the affected muscle compartment;
- Tingling or burning sensation in the skin area that covers the affected muscle compartment;
The clinical manifestations characteristic of the chronic form, on the other hand, consist of:
- Pain and / or cramps during physical activity or motor gestures that triggered the compartment syndrome. Generally, the pain and cramps disappear a few tens of minutes after the affected person has stopped exercising.
It should be noted that continuing in the activity or motor gestures that cause the pain and cramps only worsen the situation further; - Sense of numbness in the involved muscle compartment;
- Presence of a swelling in the affected muscles;
- Difficulty moving the involved limb.
COMPLICATIONS OF ACUTE COMPARTIMENTAL SYNDROME
At an advanced stage, acute compartment syndrome may be characterized by the presence of numbness in the affected muscle compartment and paralysis. These two complications are usually the sign of permanent damage to the anatomical structures that make up the affected muscle compartment.
As stated, acute compartment syndrome is a "medical emergency, the failure of which prompt treatment may make it essential to amputate the affected limb or limbs."
COMPLICATIONS OF CHRONIC COMPARTIMENTAL SYNDROME
Chronic compartment syndrome is not a "medical emergency."
However, it should be noted that the lack of rest of the affected muscle compartment can cause permanent damage to the latter. This damage can affect not only the muscles of the compartment, but also the nervous structures or blood vessels.
Diagnosis
Typically, the diagnostic process leading to the identification of compartment syndrome includes physical examination, history and, sometimes, measurement of pressure within the muscle compartment suspected of causing symptoms.
The use of an examination such as x-ray radiography is only done to exclude conditions from the similar symptom picture (differential diagnosis).
OBJECTIVE EXAMINATION AND HISTORY
The physical examination is the set of diagnostic maneuvers, carried out by the doctor, to verify the presence or absence, in the patient, of the signs indicative of an abnormal condition.
For example, in the case of compartment syndrome, some typical diagnostic maneuvers are:
- The compression of the painful area. This allows to understand the severity of the pain;
- The movement of the limb that the patient complains is painful. This allows to understand which gesture causes pain.
The anamnesis, on the other hand, is the collection and critical study of the symptoms and facts of medical interest, reported by the patient or his family (N.B: family members are involved, above all, when the patient is small).
PRESSURE MEASUREMENT
To quantify the pressure of a muscle compartment, doctors use a blood pressure gauge, which they connect to the area of interest by means of a special needle.
In general, the evaluation of compartmental pressure involves the execution of two measurements: one during a physical activity or a motor gesture that involves the painful limb and one at the end of this activity or gesture.
Treatment
The goal of treating compartment syndrome is to reduce the pressure inside the muscle compartment in order to re-establish blood flow within the latter and avoid tissue necrosis.
The therapy foreseen in case of acute compartment syndrome has some differences from the therapy foreseen in case of chronic compartment syndrome. In the next two sub-chapters, readers will have a chance to realize what the differences are.
THERAPY OF ACUTE COMPARTIMENTAL SYNDROME
In the case of acute compartment syndrome, there is only one therapeutic choice: fasciotomy surgery.
Fasciotomy is an emergency procedure, which usually takes place in a hospital setting and during which the surgeon cuts the fascia of the affected muscle compartment in order to reduce compartment pressure.
The closure of the incision takes place not before 48-72 hours have elapsed: this is the minimum time necessary for the tissues of the muscular compartment to return to normal.
An early closure of the incision may coincide with the reappearance of symptoms.
Sometimes, the fasciotomy requires the execution of a skin transplant, to better close the intervention area.
Please note: in cases of acute compartment syndrome following the presence of a plaster cast or a too tight bandage, the therapeutic solution is to remove the aforementioned plaster cast or the aforementioned too tight bandage.
THERAPY OF CHRONIC COMPARTIMENTAL SYNDROME
First-line treatment of chronic compartment syndrome is conservative (or nonsurgical). Conservative therapy of chronic compartment syndrome includes:
- A rest period. The rest of the affected muscles is essential for the achievement of healing and to avoid the appearance of complications;
- Physiotherapy exercises for stretching the muscles of the affected muscle compartment. Generally, the practice of muscle stretching should take place a few days after the rest phase has begun;
- The administration of non-steroidal anti-inflammatory drugs, ie NSAIDs;
- The elevation of the affected limb;
- The application of ice on the painful area at least 4-5 times a day. The ice packs have an incredible anti-inflammatory power. Each pack must have a minimum duration of 15 minutes and must not exceed 20 minutes.
If these remedies are ineffective and the symptoms persist, the only therapeutic solution that can be adopted is the fasciotomy surgery.
People who play sports regularly and who have suffered from chronic compartment syndrome in the past may develop the same condition again (relapse).
To reduce the risk of a recurrence, doctors recommend performing low-impact activities for limbs previously affected by compartment syndrome in the first period following recovery.
Prognosis
The prognosis in case of acute compartment syndrome depends on the timeliness of treatment: as stated, in fact, a delay in therapy has a "high probability of causing unpleasant consequences.
As regards, however, the chronic compartment syndrome, the prognosis of the latter depends on the attention that the patient pays to the treatments: in such situations, in fact, scrupulously adhering to the therapies prescribed by the doctor allows to achieve healing with excellent results and without compartment syndrome leading to complications.
