How Acute Compartment Syndrome can Cause Irreversible Nerve Damage

What is Acute Compartment Syndrome?

Acute compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body.  Acute compartment syndrome usually occurs in the legs or arms, but may affect any compartment, including the hand, forearm, upper arm, abdomen, buttock and entire lower extremity. The excessive pressure in the body compartment causes nerve damage due to decreased blood supply.  Anticoagulation therapy and bleeding disorders significantly increase the risk of acute compartment syndrome.

Groups of organs or muscles are organized into areas called compartments. Strong webs of connective tissue called fascia form the walls of these compartments. The walls of fascia cannot easily expand and when compartment pressure rises, there can be a lack of blood flow to the affected tissues.

Acute compartment syndrome is an emergency medical condition. If the pressure within the muscle compartment is not released within a few hours, permanent muscle and nerve damage may occur.

The Signs and Symptoms of Acute Compartment Syndrome

The first sign of acute compartment syndrome are numbness, tingling and paresthesias.  Pain is usually described as exquisite, deep, constant and out of proportion to the findings on physical injury. Doctors should maintain a high level of suspicion for acute compartment syndrome when dealing with extremity pain.

The symptoms of acute compartment syndrome include:

  • A new and persistent deep ache in an arm or leg,
  • Pain that seems greater than expected for the severity of the injury,
  • Numbness, pins and needles, or electricity-like pain in the limb,
  • Swelling, tightness and bruising.

Examination of the extremity often reveals tense and shiny skin that may be significantly bruised. The late manifestation of acute compartment syndrome includes the absense of a distal pulse.

How to Diagnose Acute Compartment Syndrome

A diagnosis of acute compartment syndrome requires direct measurement of pressures inside the body compartment. To do this, a needle is inserted into the suspeccted compartment while an attached pressure monitor records the pressure. Laboratory and imaging tests can support the diagnosis, but no test other than a direct pressure measurement can make the diagnosis of acute compartment syndrome.

The compartment pressure is normally about 0-15 mmHg of pressure.  If the pressure of the compartment increases (usually greater than 30-45 mmHg), most persons develop compartment syndrome. The dangerously high pressure in compartment syndrome impedes the flow of blood to the affected tissues.

Treatment for Acute Compartment Syndrome

Treatment for acute compartment syndrome is emergency surgery (fasciotomy) that focuses on reducing the pressure in the body compartment.  Once acute compartment syndrome is diagnosed, there is no non-surgical alternative.  During surgery, a surgeon makes long incisions through the skin and the fascia layer underneath (fasciotomy), releasing the excessive pressure. The muscle compartment is cut open to allow muscle tissue to swell, decrease pressure and restore blood flow.  Failure to relieve the pressure can result in the death of the muscle and nerve in the extremity.

If acute compartment syndrome is suspected, the affected limb should be placed at the level of the heart. Elevation is contraindicated because it decreases blood flow.  Compartment syndrome may be a complication of bandages or casts that are applied too tightly. When compartment syndrome is suspected, all bandages and casts should be removed.

The goal of decompressive surgery is to restore blood flow to the muscle and nerve within 6 hours. Some experts believe that compartment syndrome in the leg or arm needs to be treated within 6 hours to prevent muscle necrosis.

Do You have Questions about Acute Compartment Syndrome?

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