Compartment Syndrome

Diagnosis

Acute compartment syndrome is usually diagnosed based on the history (was there trauma?) and physical exam findings (extreme pain and swelling). When there is doubt about the diagnosis, the doctor will usually perform compartment pressure testing. The test involves numbing the area to be tested with a needle and local anesthesia. Once you are numb, a pressure gauge device with a needle is inserted into the chosen compartment and a pressure amount is measured. If the pressure is greater than 30 mmHg, then surgery is needed right away. It only takes about four hours before the high pressure will start to damage the muscles, nerves and blood vessels in the compartments.

The doctor may take x-rays of your legs or feet to make sure you do not have a stress fracture. An MRI is also sometimes used to help with the diagnosis. The gold standard (best test) for diagnosing compartment syndrome is compartment pressure testing. Compartment pressure testing is done twice, once before you exercise and once after you exercise. It is best to try and perform the exercise that brings on the pain, so bring shoes, clothes, bike, etc. so you will be able to recreate the pain. Not all compartments (4 in the leg, 9 in the foot) are usually tested, but it depends on how many places you feel pain. The actual test involves numbing the area to be tested with a needle and local anesthesia. Once you are numb, a pressure gauge device with a needle is inserted in the chosen compartment and a pressure amount is measured. The test is considered positive if you have a pressure greater than or equal to 15 mmHg before exercise or greater than or equal to 30 mmHg one minute after exercise or greater than or equal to 20 mmHg five minutes after exercise.

Treatment

Acute compartment syndrome is a medical emergency and requires a surgical fasciotomy if the compartment pressure is greater than 30 mmHg. A fasciotomy involves making an incision in the skin to open the compartment and relieve the pressure. If acute compartment syndrome is not treated right away, you could develop deformity, paralysis, weakness and sensory nerve loss.

Conservative treatment for chronic compartment syndrome may include decreased exercise and then slow return to regular exercise, non-steroidal anti-inflammatory drugs (NSAIDs), orthoses, shoe gear changes, cross-training, sports massage and physicial therapy. If conservative treatment does not work, then a surgical procedure called a fasciotomy is usually the next step. A fasciotomy involves making an incision in the skin to open the compartment and relieve the pressure. If more than one compartment is a problem, then more than one incision may be needed. Most studies have shown good results with 52% to 95% success rates reported. The surgery does have possible complications such as infection, delayed wound healing and nerve damage. An 11% complication rate has been reported. Chronic compartment syndrome can reoccur at a rate of 3% to 12%.

_Sources:

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Cetinus E, Uzel M, Bilgic E, Karaoguz A, Herdem M. Exercise induced compartment syndrome in a professional footballer. Br J Sports Med. 2004 Apr;38(2):227-9.

Fulkerson E, Razi A, Tejwani N. Review: acute compartment syndrome of the foot. Foot Ankle Int. 2003 Feb;24(2):180-7.

Hans KM, Wille J, de Vries JP. [Acute compartment syndrome of the foot]. Ned Tijdschr Geneeskd. 2004 Nov 6;148(45):2231-4.

Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ. Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg. 2007 Dec;73(12):1199-209.

van Zoest WJ, Hoogeveen AR, Scheltinga MR, Sala HA, van Mourik JB, Brink PR. Chronic deep posterior compartment syndrome of the leg in athletes: postoperative results of fasciotomy. Int J Sports Med. 2008 May;29(5):419-23. Epub 2007 Sep 13.

Verleisdonk EJ. The exertional compartment syndrome: A review of the literature. Ortop Traumatol Rehabil. 2002 Oct 30;4(5):626-31.

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