Compartment Syndrome: Treatment, Cost and Side Effects

Compartment syndrome is a condition which is characterized by the buildup of excessive pressure within the muscles. It leads to decreased blood flow to and from the tissue and prevents nourishment and oxygen from reaching the nerve and muscle cells. These muscles, nerves and blood vessels are grouped together into compartments that are located in your arms, legs and abdomen. These compartments are enclosed by a web of connective tissues known as fascia. The role of fascia is to keep the tissues in place, and therefore, the fascia does not stretch or expand easily.

Because the fascia does not expand in the event of a bleeding or injury, pressure on the nerve, tissues and muscles increases leading to disruption in the blood flow. This results in damage of muscles and nerves. The severity of the condition leads to sub classification of Compartment syndrome into acute and chronic. In acute compartment syndrome, severe injury leads to permanent muscle damage and can be fatal for a person. This requires immediate medical intervention. Chronic compartment syndrome which is also known as exertional compartment syndrome is often caused by athletic exertion.

The cause of compartment syndrome varies and depends on whether you have acute or chronic. Acute compartment syndrome usually occurs after a severe injury like car accident or broken bone. Other factors responsible for acute compartment syndrome includes fracture, prolonged compression of limbs during a period of unconsciousness, a blood clot in a blood vessel, crush injuries, constricted bandages and anabolic steroids. For chronic compartment syndrome, the cause is often exercising like running, bicycling, or swimming.

A diagnosis for compartment syndrome usually includes a physical examination by your doctor. A sure way of identifying the condition is measuring the compartment pressure inside the body. Additional tests may include laboratory and imaging tests (which is usually done in case of chronic compartment syndrome). Therefore, treatment is based on the type of compartment syndrome you have.

For acute compartment syndrome, surgery is the only way to treat the condition. Surgery requires making an incision and opening up the skin and fascia affected compartment. This procedure is called fasciotomy. However, the skin incision is not always closed due to the severity of the swelling. The incision is surgically repaired when swelling subsides and often skin grafting may be needed. There are other treatments given for supporting the surgerical procedure like giving oxygen through the nose or mouth, giving fluids intravenously and keeping the body part below the level of the heart. On the other hand, chronic compartment syndrome needs physical therapy or orthotics (inserts for shoes) and anti-inflammatory medicines. In most cases, the condition disappears after you stop exercising or doing a particular physical activity. But in rare cases, chronic compartment syndrome may require surgery (fasciotomy). Usually, the skin incision for chronic compartment syndrome is shorter and is an elective procedure rather than an emergency.

It is very important to remember that acute compartment syndrome requires immediate medical supervision and a person having should be taken immediately to a hospital. You may experience symptoms like intense pain which is increased while doing stretching, tingling or burning sensation (paresthesias) of the skin, muscles feeling tight or full and numbness or paralysis.

People suffering from chronic compartment syndrome may experience numbness, difficulty in moving the affected body part and visible muscle bulging. If you are having any of these symptoms, go to a doctor or orthopedic immediately for a proper diagnosis and treatment.

Anyone who does not show the symptoms of compartment syndrome or is having similar symptoms due to bone fracture or ligament injury is not eligible for treatment.

Surgery is the most effective treatment for acute and chronic compartment syndrome as it relieves the pressure inside a compartment in the body. But it does have numerous side effects like infection, permanent nerve damage, numbness and scarring. Treatment for chronic compartment syndrome has no possible side effects. Anti-inflammatory medicines which are used for treating chronic compartment syndrome also has a few side effects like stomach pain and heartburn, stomach ulcers, headaches and dizziness, allergic reactions such as rashes, wheezing and throat swelling and high blood pressure.

Other than side effects, there are a few complications of compartment syndrome like muscle scarring, contracture and loss of function of the limb also known as rhabdomyolysis and kidney damage.

There are no definite post-treatment guidelines for compartment syndrome. However, doctors might advise you to take complete bed rest for a few weeks and avoid lifting any heavy items. You should also refrain from doing any sort of physical activity or rigorous exercise as it may lead muscle exhaustion and weakness. Try to follow a balanced and healthy diet to recover faster. You can also practice yoga and meditations regularly to calm yourself down. In some cases, your doctor will suggest physiotherapy for muscle relaxation and better movement and coordination of legs and arms. If you are feeling any sort of pain or muscle weakness, go to your doctor immediately.

Recovery for compartment syndrome will depend on the type you have. If you have acute, then you require surgery which will usually take 4 weeks to a month to recover. However, if you have chronic compartment syndrome, then you may need one to two weeks to recover fully.

The surgical cost for acute compartment syndrome is usually high and range from Rs.1,00,000 to Rs,5,00,000.

Yes, the results of the treatment are permanent and does not reoccur after a period of time.

There are no alternative treatments for acute compartment syndrome but yo can try cross-training activities if you have suffered chronic compartment syndrome.