No matter how many definitions of this I read, I don’t grasp what it is.
In: Biology
There are two categories of compartment syndrome – acute and chronic. The acute type happens rapidly after an injury, such as a fracture, a crush injury, or a burn, and the chronic type is repetitive, multiple episodes over time. The acute type is really, really bad, and the patient needs to go right to surgery. Chronic, not so bad, but still requires treatment.
Compartment syndrome is named after the fact that the muscles in your extremities are divided by sheets of fascia into different compartments. If you’ve ever seen a deer skinned, fascia is the silvery, almost see-through covering over the muscles. It exists not only on the outside of the muscles, but also runs between them. Between compartments, that fascia is tough and cannot expand if the pressure rises in that compartment. Acute compartment syndrome can occur from bleeding into the compartment (fracture, crush injury), or swelling from fluid leaking out of blood vessels (burns). Chronic compartment syndrome occurs with exercise, so it’s called chronic exertional compartment syndrome (CECS) because, well, you get it from exertion. Some people do, that is. For unknown reasons, some people’s muscles swell more with exercise, which raises the pressure within the compartment the swollen muscle resides in.
The result of increasing pressure within a compartment is that smaller blood vessels are compressed, and so oxygen cannot get to tissues (such as muscle), since the blood has to reach the capillaries (the smallest of blood vessels), where the oxygen enters tissues. Compartment syndrome is extremely painful. In CECS (chronic), the pain causes the person to stop exercising, and the muscle then shrinks back down to normal size, and blood flow is restored. Then they exercise again, and the cycle repeats. CECS typically does not cause muscle damage, although I had one case in which it did cause mild damage, which was noticed at surgery. It was thought that the patient’s pressures were particularly slow to drop after stopping exercise, so the muscles were exposed to a longer than usual period of high pressure.
In acute compartment syndrome, there is nothing that can decrease the pressure, other than surgically opening the compartment by slicing the fascia. It’s considered an emergency, and you have about 8 hours to do this after onset of, otherwise the affected muscles will die from lack of oxygen. In CECS, you can still slice the fascia to treat it, but it’s an elective surgery, not an emergency.
Diagnosis is accomplished by inserting a needle that is connected to a digital pressure gauge into the compartment and taking a reading. I use ultrasound guidance when I do this, so I can be sure of which compartment I am testing and also avoid blood vessels and nerves with the needle.
source: I’m a sports medicine doctor
Latest Answers