The human body is very complex. The muscles in a person’s arms and legs are bounded by tissue in several compartments. Should the muscles in these compartments swell more than a normal amount, then the space will become limited and the muscles will not be able to function properly. When this occurs it is called compartment syndrome. This is a painful medical condition where the blood supply in the compartments is cut off and the tissue is damaged. The results of this can be very serious.
Prompt diagnosis and treatment is extremely important to avoid even greater injury and disability. There are many causes of compartment syndrome:
- Fractures of the tibia
- Vascular injury
- Crush injuries
- Penetrating injuries
- IV-drug use
- Too-tight cast or dressing
Compartment syndrome can be either chronic or acute. Chronic compartment syndrome can occur with repetitive stress. This causes pain which will often subside within 1-2 hours of stopping the activity. However it can return when the activity resumes. There are also cases where there is “acute on chronic” compartment syndrome and the pain does not subside and the compartment pressure increases over hours or even days. Persons suffering from acute chronic compartment syndrome are at serious risk and they usually require emergent medical treatment due to the short window in which diagnosis and treatment needs to occur in order to avoid muscle or nerve damage.
It is very difficult to diagnose compartment syndrome. The only symptom that seems to be consistent is pain that is greater than expected for the injury or condition the patient suffered. Conducting a physical examination may not reveal many signs of compartment syndrome. The limb affected may appear to be swollen or tight. Sensory nerves are often more affected before motor nerves; sensory findings on tests may be an early finding. One late finding is the inability to dorsiflex. Major sensory deficit or loss of peripheral pulses can indicate that the compartment syndrome may be advanced.
There is only one effective treatment for compartment syndrome and that is urgent fasciotomy to relieve the pressure in the compartment and restore muscle perfusion. If left untreated, compartment syndrome can lead to muscle and nerve death in the limb affected, as well as potentially amputation or even death.
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