Compartment syndrome is a condition caused by swelling within the space or “compartment” that contains muscles, nerves, blood vessels and bones. Pressure on arteries, veins and nerves causes severe pain and slows the circulation to these parts potentially causing permanent damage. Acute compartment syndrome is a medical emergency requiring immediate attention. Chronic compartment syndrome is not a medical emergency and manifests itself in the form of pain and swelling following exercise. It usually occurs in the leg and symptoms dissipate quickly when activity stops.
In acute compartment syndrome, muscles in the arms, hands, legs and buttocks are affected. Swelling and/or bleeding within the compartment puts pressure on the capillaries, causing them to collapse and in turn disrupting the supply of oxygen and nutrients to the cells. One cause of compartment syndrome may be wearing a cast or splint that is too tight. Other causes could be severe trauma to a muscle during sports or through a motor vehicle accident or complication after surgery.
The most common symptom of acute compartment syndrome is pain that is out of proportion to the injury. A tingling or burning sensation (paraesthesia) in the muscle may be present, in more severe cases the body part will become extremely painful or even numb. A feeling of fullness or tightness in the muscle could also be a sign of compartment syndrome.
For acute compartment syndrome, surgery may be necessary to relieve the pressure in the compartment. If surgery is not warranted, the doctor may advise avoiding the activities that cause the condition, icing and elevation of the limb, the use of aspirin or ibuprofen to relieve inflammation and wearing shoes with a cushioned sole in them.
The difference between acute and chronic compartment syndromes is that with chronic compartment syndrome the symptoms are aggravated with exercise and eased with rest whereas with acute compartment syndrome there is a constant pain.
The most common chronic compartment syndrome is in the shin and can often be mistaken for shin splints. Through a proper subjective and physical examination, we will be able to distinguish between these two conditions.
With chronic compartment syndrome the fibrous tissue surrounding the muscles in the shin area, known as the fascia, may become excessively thickened with exercise such as running. The muscles then become compressed in this thickened tight fascia when they expand during exercise and the nerves and blood vessels may also become compressed causing pain. When the muscle relaxes following exercise and returns to its normal size, the compartment has room once again for the blood vessels and nerves without compressing them so the pain dissipates,
Sometimes surgery is recommended for chronic compartment syndrome. Post-surgical physiotherapy rehabilitation is essential and may include ice, passive joint mobilisation, range of motion exercises and a graduated strengthening programme until there is a full return to regular sport.
Sometimes physiotherapy treatment such as deep massage of the fascia of the shin to decrease the thickening as well as ice or ultrasound, passive joint mobilisation and advice on footwear and running technique is enough to resolve a chronic compartment syndrome without the need for surgery.