What Is Compartment Syndrome?
Compartment syndrome is when pressure increases within a fascial compartment, causing severe pain.
What causes compartment syndrome?
Fascial compartments are found all over the body, such as in the hand, forearm, upper arm, the buttocks, the leg, the foot and the abdomen. They are confined spaces within the deeper layers of tissue (called the fascia), in which can be found nerves, blood vessels and muscle tissue. The compartment is surrounded by fascia, just as wires are surrounded by insulation.
Problems will occur if pressure increases within a fascial compartment because the fascia surrounding it cannot expand. The muscles, nerves and blood vessels within the compartment will therefore become compressed, blocking the blood flow and oxygen supply. This will damage the muscles and nerves, causing severe pain and, eventually, muscle necrosis (death).
This increase in pressure can be caused by anything that causes swelling of the muscles and tissues within the fascial compartment. This can include:-
- A fracture;
- Vigorous exercise;
- Burns;
- Crushing injuries;
- Penetrating injuries;
- Bleeding from an injured blood vessel;
- Intravenous medicines that leak inside the arm.
How is compartment syndrome diagnosed?
Compartment syndrome will be suspected by a doctor if there is a recent history of injury and the characteristic symptoms are present. These symptoms include:-
- Severe pain that is disproportionate to the injury;
- Pain on rest and on movement;
- Pins and needles;
- Tightness and a burning sensation;
- Reduced sensation on the skin;
- Pale, cold skin that feels tense or hard.
If a patient is complaining of these symptoms and has a recent history of trauma, compartment syndrome should be expected. A diagnosis can be verified by an MRI scan or with a device that measures pressure within the fascial compartment.
How to treat compartment syndrome
Compartment syndrome should be treated as quickly as possible to prevent permanent damage. Oxygen and intravenous fluids should be administered immediately, after which a fasciotomy should be arranged. This is a surgical procedure which opens the fascial compartment, allowing the pressure inside to be relieved. The wound if often left open for a while to ensure pressure does not build up again. When the problem is thought to have resolved, the cut can be stitched closed.
If there is a delay in treatment, the pressure within the fascial compartment will soon damage the muscle and nerves. This happens because the blood supply is blocked, thereby preventing the flow of oxygen. This lack of oxygen causes the nerves and tissue to break down until they actually die. When the tissue becomes necrotic it cannot be repaired and it must be surgically removed.
If compartment syndrome does lead to permanent complications and this occurred because medical professionals did not make a timely diagnosis, there could be grounds for a compensation claim.
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