Injuries are common at all stages of life, from childhood through the growing years and into adulthood. While the level of injury varies – from a bruise to compound fractures and everything in between – not all injuries are tended to, and understandably so. After all, the pain and visible indicators of severity (bleeding, inflammation, etc.) are what everyone goes by before deciding whether to ignore and let the injury heal on its own or give it medical attention. This callousness should be avoided, say experts, adding that ignoring pain or wounds could result in underlying conditions such as compartment syndrome going undetected, leading to complications.
Judging the severity of injury superficially could bring about repercussions later. While you might only see swelling or a mild bruise on the surface, the tissue might be dying underneath, and you won’t even realise it. Compartment syndrome is one such condition which causes muscle damage within the body.
What is compartment syndrome?
Compartments are spaces formed by grouping of muscles in the arms and legs. These muscles have their intricate network of nerves and blood vessels and are covered by a membrane called fascia, which doesn’t easily stretch or expand.
The review paper, Compartment syndrome: Challenges and solution, defines the condition as an increased pressure within a compartment because of which there is a decreased tissue perfusion to structures within that space. This leads to restricted circulation in the muscles within the compartment, leading to irreversible blood flow damage (neuromuscular ischemia) to that specific part.
Since it leads to tissue damage, early diagnosis is very crucial. Compartment syndrome is considered a surgical emergency.
Types and symptoms of compartment syndrome
“Compartment syndrome is a condition usually seen in the forearm or the leg, where in there are tight compartments,” says Dr Deepak Inamdar, an orthopedic surgeon at Orthopedic and Robotic Joint Replacement Center, Bengaluru. “Usually, it’s seen in the arm in children and in the leg in adults.”
There are two types of compartment syndrome – acute and chronic.
Acute compartment syndrome (ACS) is seen more often compared to the chronic type. It usually occurs after trauma in the limb and is characterised by pain. It often gets overlooked as the pain is usually attributed to the injury.
“It’s usually seen following an injury or a fracture, wherein the compartment has a limited amount of space. So, the bleeding and the increased pressure cause problems to the blood vessels and nerves,” says Dr Inamdar.
Chronic compartment syndrome is quite rare and is seen in athletes who experience exercise-induced pain frequently.
Diagnosis and treatment
Acute compartment syndrome needs surgical intervention.
“It includes a clinical diagnosis, where in you check the pulse, stretch pain and compartment pressure,” says Dr Inamdar. “There are devices which can check the compartment pressure. One can insert a needle into the muscle connected to the BP [blood pressure] apparatus to check the compartment pressure.”
When the compartment pressure is high, immediate decompression is required, which is done by fasciotomy (a surgery to relieve the compartment pressure).
“If the pressure is disproportionate, then the compartment must be opened immediately. That’s the only way to reduce the compartment pressure,” adds Dr Inamdar. “Decompression is done surgically. We cut open the compartment completely, so that the muscles get breathing space. After a period, you can perhaps put a skin graft on the decompressed area,” he adds.
ACS can be dangerous and needs immediate treatment. If the decompression is not done within eight hours, then tissue necrosis (death) occurs.
“If one comes late, the doctor can remove the dead muscles followed by some plastic surgery procedures. Hence, it’s important to intervene early,” says Dr Inamdar.
Treatment of chronic compartment syndrome or chronic exertional compartment syndrome can include non-surgical methods. This is done by suggesting the individual to change or decrease the level of activity that is causing it. But since athletes are usually reluctant to ease off training, fasciotomy is considered.
Takeaways
- Increased pressure in the compartments restricts the flow of the blood and nutrients to the tissues. This causes tissue damage, ultimately leading to compartment syndrome.
- Compartment syndrome can be acute or chronic. Acute compartment syndrome is caused by injuries and fractures, while chronic compartment syndrome usually seen in athletes who experience exercise-induced pain.
- Acute compartment syndrome requires an early diagnosis and can be treated surgically, whereas chronic compartment syndrome can be treated both surgically and non-surgically.
