COMPARTMENT SYNDROME
by Dr Mark A Jenkins MD
The compartment syndrome is a condition in which increased pressure within a
muscle compartment causes a decrease in blood supply to the affected muscles.
The so-called compartments are groups of muscles surrounded by inelastic fascia
and thus any swelling of muscles leaves no room for expansion and blood supply
is progressively cut-off.
Compartment syndromes can be acute -- as is seen in high energy trauma (eg.
car accidents) and burns -- or chronic, which is seen as an overuse injury in
an athlete. The acute situation is generally a medical emergency since rapidly
increasing pressure may completely cut off blood flow and cause necrosis of the
affected limb. The chronic compartment syndrome which occurs as an overuse
injury is most commonly seen in the muscles of the lower extremity but has also
been described in the forearm and the thigh. The mechanism of development of
the chronic compartment syndrome is thought to be,
OVERUSE ----> LOCAL TISSUE SWELLING ---->TIGHT COMPARTMENT
TIGHT COMPARTMENT---->DECREASED BLOOD SUPPLY----->MORE TISSUE SWELLING
A vicious cycle can become established.
What the athlete experiences is pain that begins during activity,
progressively worsens, and then ceases during rest. This is distinct from the
pain of other overuse injuries. The pain associated with tendinitis usually
begins as soon as exercise is started, lessens with continued exercise -- as
the muscles and tendons warm-up -- and then returns after exercise is stopped.
To accurately diagnose the chronic compartment syndrome, pressure testing
within a muscle compartment can be performed. A flexible plastic catheter is
inserted through a small slit in the skin into a muscle compartment. The
catheter is hooked up to a pressure transducer and the pressure within the
compartment is measured. The athlete then engages in the pain inducing activity
(eg. running on a treadmill) while a continual recording of compartment
pressure is made. Reproduction of painful symptoms associated with pressures
above a certain value confirms the diagnosis.
- Treatment consists of
- correction of any biomechanical abnormalities
- soft tissue therapy
- and in severe cases not responding to the above, surgery.
Of interest to readers is that running tends to cause higher lower extremity
intracompartmental pressures than does cycling.
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