Compartment Syndrome

What is compartment syndrome?

Compartment syndrome is pain and swelling caused by swollen muscles pressing against the sides of the compartment (or sheath) that surrounds the muscles. The sheath is called the fascia.

This problem happens most often:

• in the leg between the knee and ankle
• in the thigh between the hip and the knee
• in the arm between the elbow and wrist

What is the cause?

Injury or overuse of the muscles of the lower leg or forearm can cause compartment syndrome. These injuries can cause tissues in the area to swell. Fascia do not expand, so swelling cuts off circulation of blood to ligaments, muscles, and nerves. This affects the injured area and the area below the injury.

The compartments in the lower leg are generally most affected. People who run a lot have the highest risk of this injury.

What are the symptoms?

The symptoms usually occur in the area of the affected compartment of the forearm, thigh, or leg. They may include:

• pain
• swelling
• weakness
• tenderness over the front of the shin
• tingling or numbness of the leg, foot, or hand
• foot drop (you cannot lift your toes, so you have to limp to keep your foot from dragging)
• pain when you flex or point the big toe

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have a needle test to measure the tissue pressure within the compartment. For this test, you will be given a shot to numb the area. Then your provider will put a needle attached to a measuring device into the muscle compartment to measure the pressure while you are resting. Then your provider will remove the needle and you will exercise to cause the symptoms. Then your provider will use the needle again to measure the pressure. The diagnosis is made if the pressure rises significantly after exercise.

How is it treated?

To reduce swelling and pain in the first day or two, your healthcare provider will probably tell you to:

• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth, on the painful area every 3 to 4 hours for up to 20 minutes at a time.
• Raise the injured area on a pillow when you sit or lie down.
• Take an anti-inflammatory medicine, such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.

For more severe injuries, you may have tests, such as an arteriogram, to find where the blood flow to the area is stopped.

Sometimes surgery is needed to release the pressure. Releasing the pressure from swollen tissues decreases swelling and brings blood flow back to the area. Use of your muscles and nerves, as well as blood flow, must be restored to prevent a loss of those muscles and nerves (paralysis).

How can I take care of myself?

• Follow your treatment plan.
• Follow your provider’s instructions for doing exercises to help you recover.
• Keep all appointments for provider visits or tests.
• Contact your healthcare provider if you have new or worsening symptoms.

How can I help prevent compartment syndrome?

• Do warm-up exercises before you exercise more vigorously.
• Gradually increase your exercise level for any job-related activity or exercise that requires constant use of lower arms and leg muscles.