What is Compartment Syndrome?
In the human arms and legs, there are sections of muscle that contain blood vessels, muscle tissue and parts of the nervous system. These are muscle compartments. The muscle compartments are surrounded by a somewhat rigid web of interconnective tissue called the fascia, which does not expand easily to accommodate any changes in pressure (x). When these muscles take on damage (usually due to bone fractures or even blunt trauma), they swell or bleed, and pressure starts to build up in the compartments. The pressure causes further injury to the muscle tissue, nerves and vessels, resulting in a rather painful condition called compartment syndrome (x).
Compartment syndrome is a severe condition that is treated as an emergency. Lack of prompt treatment may result in serious tissue damage due to pressure build-up, which leads to reduced oxygen circulation in the cells, a condition called ischemia. Eventually, the cells become weak, dysfunctional and start dying (necrosis). At this point, anything is possible, including paralysis and death.
Compartment Syndrome Characteristics
When the muscles are injured, they bleed and swell, releasing both blood and edema in the compartment. Coupled with the increased volume of the muscles, these fluids start exerting more pressure in the compartment. The fascia is not flexible and does not expand to accommodate these changes (x). Instead, the pressure continues increasing and soon starts to affect blood flow into the cells. When left unchecked, the tissues eventually fail to receive enough nourishment and accumulate waste. This impairs their functioning. They start weakening and soon become damaged. Consequently, they die, and the entire organ becomes permanently damaged.
This mostly occurs and affects the arms, legs and abdomen, though other parts of the body such as the feet and hands can be affected too.
Types of Compartment Syndrome
Acute Compartment Syndrome
Acute compartment syndrome usually occurs only a few hours after one sustains a severe injury, especially one that causes fracturing or breaking of the bones. Rarely, it can also result from minor injuries.
This form of the condition requires immediate relief. Otherwise, the victim may suffer tissue death and even permanent disability (x). One may have to amputate the affected organ.
Acute compartment syndrome in the legs is the most common form, but it could also affect the arms, buttocks, hands and feet (x).
Acute Compartment Syndrome Causes
- A violent accident that may cause a bone fracture
- Use of anabolic steroids (variations of the hormone testosterone)
- A deep bruise to the muscle — this usually occurs when one is hit violently with a blunt object that doesn’t necessarily penetrate the skin (for example, when a heavy object falls on the leg, or when the arm is miscued with a hard object)
- Correction of blood flow after circulation blockage — this could be caused by sleeping for too long in a position that impedes blood flow (though uncommon, some people will sleep through the night in one position)
- Constricting clothing, bandages or casts
- Crash accident
Chronic Compartment Syndrome
Chronic compartment syndrome is generally less severe than the acute form. It usually occurs in athletes, gymnasts and people who do a lot of repetitive exercises such as running or swimming. While the exact link between exercise and the syndrome remains unknown, it has been observed to occur more frequently in people under 40 years of age.
One can relieve chronic compartment syndrome by stopping such exercises (x).
Abdominal Compartment Syndrome
Although relatively rare, the abdominal compartment syndrome, also known as the exertional compartment syndrome, affects the abdomen and commonly occurs after a severe illness, invasive surgery or after a nasty injury (x). It’s considered a severe form of the syndrome as it could easily affect the functioning of critical parts such as the liver, kidneys and other organs in the abdomen. Seeing as amputation of the abdomen is not possible, immediate and proper medical attention should be sought on the first suspicion of abdominal compartment syndrome. If not, the condition may lead to permanent damage or the death of critical organs such as the liver, kidneys and even parts of the digestive system. (x) This would call for emergency transplants.
Abdominal Compartment Syndrome Causes
Abdominal compartment syndrome is associated with:
- Deep burns that extend to the abdominal muscles
- Infections that may lead to inflammation of the abdominal muscles such as sepsis
- The fracturing of the pelvic bone
- Vigorous and intense abdominal exercises such as sit-ups
- Trauma and shock
- Any surgery performed in the abdomen such as liver and kidney transplants
- Severe bleeding in the stomach region or ascites
Compartment Syndrome Symptoms
Acute Compartment Syndrome
- Persistent and deep pain in the affected muscles compartment, especially when it is stretched or when pressure is applied to it
- An unexpected amount of pain after an injury, especially when the affected part is stretched
- A feeling of tightness and fullness in the affected region
- Tingling and burning sensation (x)
Numbness and paralysis are common in the later stages when the condition is getting out of hand. Immediate medical attention is essential. Otherwise, the victim risks permanent damage to their muscles.
Chronic Compartment Syndrome
- Pain and cramping during athletics or exercise
- Pain in the affected area — it increases with movement
- Difficulty using the affected organ
- A muscle bulge that is clearly visible
Symptoms of chronic compartment syndrome usually go away when one stops exercising. For instance, the pain and cramping can go away after 30 minutes of rest. If ignored, however, the pain may start lasting for more extended periods.
Abdominal Compartment Syndrome
As previously mentioned, abdominal compartment syndrome usually occurs in people who are very ill or in the hospital, often not in a position to describe the symptoms themselves. It is, therefore, up to a doctor to diagnose the symptoms on a routine check-up. The symptoms may include:
- Swelling in the abdomen
- It appears distended, tense or tight
- The patient will wince in pain if it is touched or if they are required to sit upright or engage the abdomen in any way
- There will be problems with the urine output, such as unusually low amounts — this is due to the pressure exerted on the kidneys
Compartment Syndrome Prevention
Seeing as the syndrome mainly occurs after accidents, it is hard to prevent it. The best one can do is be careful and watch out for any signs after sustaining serious injury. Here are some steps one can take to lower the chances of contracting the syndrome (x):
- Thorough diagnosis and treatment of injuries, especially those that display the symptoms named above
- Getting a doctor to observe a cast or plaster that is tied too tightly — it is especially crucial to do so if the wrapped injury is becoming increasingly painful and the swelling is not receding
- Building endurance during exercise — don’t, however, overwork yourself and ignore the symptoms
- Wear fitting shoes
- Athletes should change their gait pattern and observe a healthy one
- Work on improving flexibility to reduce the chances of contracting chronic compartment syndrome
Compartment Syndrome Treatment
As the most obvious symptom of the compartment syndrome is swelling, the doctor may first perform a physical examination of the affected area. He or she will take a look at the swelling and ask questions regarding the time and nature of the injury. The doctor may also apply slight pressure on the affected region to determine how severe the pain is as well as rule out other similar conditions (x).
A pressure meter is typically used to find out how much pressure is in the compartment. It is attached to a needle that points to the meter and shows a reading. Usually, two readings are necessary; the amount of pressure exerted in the compartment during movement or exercise, particularly that which makes the area hurt, and the other when the muscles are at ease.
Additional tests, including x-rays, may be necessary to rule out other similar problems.
For the case of abdominal compartment syndrome, the doctor may insert a catheter attached to a pressure monitor in the urinary bladder. Laboratory tests may also accompany this.
Acute Compartment Syndrome Treatment
As mentioned earlier, this form of the syndrome is very serious. Surgery is currently the only option. The doctor simply cuts open the fascia (the inelastic tissue that surrounds the muscles) and lets off the pressure (x, x). Any edema or blood is drained out, and the muscles are given time to heal so that the swelling reduces. The section is then closed up, and sometimes skin grafting is performed as necessary. Any casts, dressings or splints in the problem area are removed (x).
Treatments of Chronic Compartment Syndrome
The first approach to chronic compartment syndrome is usually non-surgical, where the doctor suggests changes in physical indulgence and general lifestyle. Compartment syndrome natural treatment is also advised, and the doctor can prescribe some supplements to help ease the swelling. Changes that may be necessary include:
- Modifying a physical activity, especially exercise
- Avoid certain physical activities
- Resting after exercise
- Medication to reduce inflammation
- Switching the surface used for exercise
- Physical therapy to stretch out the muscles, especially after a workout
- Adding some ice on the affected part after the exercise
- Use of orthotics
If these methods don’t work, the patient has no choice but to result in surgery. Unlike acute compartment syndrome surgery, however, the incision typically is not very deep. The purpose is the same, though; to open up the fascia and let out the pressure. It is done after thorough consideration and agreement between any parties involved (x).
Supplements For Compartment Syndrome Pain Management
Magnesium is an essential mineral used by the body in more than 300 processes involving critical elements such as nerves and enzymes.
It is essential in the movement and coordination of nerve impulses in the nervous system. It is also useful in facilitating the contraction and expansion of muscles (x).
Most importantly (in this context, at least), magnesium is an anti-inflammatory agent. Low levels of it have been linked to a variety of chronic and inflammatory conditions (x).
In that regard, incorporating the supplement into pain management procedures will help ease the muscle inflammation and swelling, reducing the pain and accelerating the healing process.
Calcium is also an essential supplement. It is famous for its role in strengthening bones. This helps in preventing acute compartment syndrome that is caused by bone fracturing. It also facilitates the movement of nerve impulses (x). It even aids in reducing inflammation (x).
Fish oil is an excellent anti-inflammatory agent and helps to treat a myriad of diseases and conditions related to inflammation (x). It is, therefore, beneficial for people suffering from chronic compartment syndrome or even those healing after surgery to relieve acute compartment syndrome.
Flaxseeds are otherwise known as superfoods and are prized for their numerous health benefits, including their high content of essential nutrients. They also contain high amounts of omega-3, which not only helps in promoting good heart health, but also in fighting inflammation (x).
The Bottom Line
Compartment syndrome is caused by increased pressure in the muscle compartments due to inflammation, swelling and injury of the muscles. Acute compartment syndrome is typically caused by deep injury to the tissue while the chronic compartment syndrome results from strenuous exercises.
The symptoms of the syndrome include swelling, a feeling of tightness, a surprising amount of pain after an injury and deep pain when the affected part is exerted. Diagnosis is usually made through physical examination, pressure monitoring and additional laboratory tests. Acute compartment syndrome is particularly serious and surgery is typically necessary. One can relieve the chronic form through non-surgical methods, though surgery is also possible.
Supplements one can take to ease the pain include magnesium, calcium, fish oil and flaxseeds. They all contain anti-inflammatory properties and aid in the transmission of nerve impulses.
By: Valentine Kagwiria