What is it?

Acute compartment syndrome is a medical emergency that can affect the arms, legs, or trunk of the body. This condition is most commonly caused by an acute trauma, such as a fracture (69-75% of all cases), blunt trauma or any other injury that causes significant swelling. This extreme swelling squeezes the compartments of the body that contain muscles, blood vessels and nerves. If the pressure becomes too high, it can cut off blood flow and injure these muscles, nerves and other tissues.

If left untreated, the damage can become permanent, leading to loss of function of the arm/leg, loss of the arm/leg itself or in rare occurrences, death.

 

Symptoms

Compartment syndrome typically occurs after a fracture, high impact blunt trauma or other severe injury to the body. Rarely, it can occur without any trauma at all. Initial symptoms may include only swelling, tightness, numbness/tingling and progressively increasing pain. Anyone with swelling of a body part resulting in tightness, worsening pain even at rest and numbness/tingling should be considered at risk for compartment syndrome. Eventually, if the condition is not treated, symptoms can progress to the “5 P’s” of acute compartment syndrome:

1. Pain

2. Pale skin

3. Pulselessness (no pulse in the limb)

4. Paresthesias (numbness and tingling in the arm or leg)

5. Paralysis (inability to move the arm or leg)

 

Risks

Acute compartment syndrome is more common in young males and individuals who fracture a bone.

 

Sports Medicine Evaluation & Treatment

A sports medicine physician will first speak with the patient to see if they are experiencing any of the symptoms listed above. The physician will then perform a physical exam to test for increased pain with gentle movement/touch, abnormal sensation, abnormal pulse and weakness. If the physician is concerned about compartment syndrome, he or she will perform a “compartment pressure test,” which involves inserting a small needle into the injured area to measure the pressure. If the pressure is too high, this confirms the diagnosis.

The treatment for acute compartment syndrome requires a surgery (called a “fasciotomy”) to release the abnormal pressure in the affected compartments of the body. Again, this is an emergency situation, and the surgery needs to be done as soon as possible.

 

Injury Prevention

It is difficult to prevent acute compartment syndrome because it is usually the result of an accidental injury leading to fracture, crush injury or blunt trauma. If you have a cast due to a fracture, let your doctor know if the cast feels too tight or painful. Sometimes extreme workouts can lead to unsafe swelling of the muscles, so avoid overly strenuous workouts, especially in extreme heat. Lastly, wearing appropriate protective equipment and using a seatbelt in the car can help prevent injury. The most important issue is early recognition, so if you have any of the symptoms listed above, notify your doctor immediately.

 

Return to Play

True acute compartment syndrome requires emergent surgery. Return to play will be based upon the surgeon’s recommendations once the incisions from surgery have healed, all other associated injuries have healed and all symptoms have completely resolved.

AMSSM Member Authors
Sumit Bassi, MD and James Newman, MD

References
Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Adv Orthop. 2015:5433412.
Schmidt AH. Acute compartment syndrome. Orthop Clin North Am. 2016 Jul;47(3):517-25.
Von Keuedell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015 Sep;386(10000):1299-310.