Navigate Up

Neurology Center - A-Z Index

#
J
Q
X
Y
Z

Print This Page

Compartment syndrome

Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.

Causes

Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, similar to the way in which insulation covers wires.

Fascia do not expand. Any swelling in a compartment will lead to increased pressure in that area, which will press on the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the arm or leg will no longer work. It may need to be amputated.

Swelling that leads to compartment syndrome occurs from trauma such as a car accident or crush injury, or surgery. Swelling can also be caused by complex fractures or soft tissue injuries due to trauma.

Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running. The pressure in a compartment only increases during that activity.

Compartment syndrome is most common in the lower leg and forearm. It can also occur in the hand, foot, thigh, and upper arm.

Symptoms

Compartment syndrome causes severe pain that does not go away when you take pain medicine or raise the affected area. In more severe cases, symptoms may include:

  • Decreased sensation
  • Numbness and tingling
  • Paleness of skin
  • Severe pain that gets worse
  • Weakness

Exams and Tests

A physical exam will reveal:

  • Pain when the area is squeezed
  • Extreme pain when you move the affected area (for example, a person with compartment syndrome in the foot or lower leg will have severe pain when moving the toes up and down)
  • Swelling in the area

To confirm the diagnosis, the doctor or nurse may need to directly measure the pressure in the compartment. This is done using a needle attached to a pressure meter, which is placed into the body area. The test must be done during and after an activity that causes pain.

Treatment

Surgery is needed immediately. Delaying surgery can lead to permanent damage.

Long surgical cuts are made through the muscle tissue to relieve the pressure. The wounds can be left open (covered with a sterile dressing) and closed during a second surgery, usually 48 to 72 hours later.

Skin grafts may be needed to close the wound.

If a cast or bandage is causing the problem, the dressing should be loosened or cut to relieve the pressure.

Outlook (Prognosis)

With prompt diagnosis and treatment, the outlook is excellent that the muscles and nerves inside the compartment will recover. However, the overall outlook is determined by the injury that led to the syndrome.

If the diagnosis is delayed, permanent nerve injury and loss of muscle function can result. This is more common when the injured person is unconscious or heavily sedated and cannot complain of pain. Permanent nerve injury can occur after 12 to 24 hours of compression.

Possible Complications

Complications include permanent injury to nerves and muscles that can dramatically impair function. This is called Volkmann's ischemia .

In more severe cases, amputation may be required.

When to Contact a Medical Professional

Call your health care provider if you have had an injury and have severe swelling or pain that does not improve with pain medications.

Prevention

There is probably no way to prevent this condition. Early diagnosis and treatment helps prevent many of the complications.

If you wear a cast, be aware of the risk of swelling. See your health care provider or go to the emergency room if pain under the cast increases, even after you have taken pain medicines and raised the area.

References

Gulgonen A, Ozer K. Compartment syndrome. In: Wolfe SE, Hotchkiss RN, Pederson WC, Kozin SH, eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier Churchill Livingston; 2012:chap 57.

Jobe MT. Compartment syndromes and Volkmann contracture. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 74.

Updated: 9/8/2014

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com