Definition

When you have acute compartment syndrome (ACS), pressure builds up inside the enclosed spaces that hold muscles, nerves, and blood vessels. This prevents the muscles from getting oxygen. ACS can affect the arms, hands, legs, feet, and buttocks.

Compartment Syndrome in Lower Leg

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Causes

Under the skin of the arms and legs are sheets of connective tissue called fascia. These wrap around groups of muscles, nerves, and blood vessels. They create a unit called a compartment. When pressure builds up in these enclosed spaces, it has nowhere to go. The pressure is redirected into the compartment. When pressure reaches a certain point, it disrupts blood flow. In ACS, trauma speeds up this process. Blood vessels may fail, and tissue dies.

Common causes include:

  • Traumatic injury (eg, from a car accident, sport injury, gunshot wound)
  • Fracture (linked to most cases)
  • Vein obstructions
  • Burns
  • Hemorrhage
  • Edema (swelling of tissues under skin)
  • Complication of surgery

Risk Factors

These factors increase your chance of developing ACS:

  • Pre-existing condition that could lead to fatal bleeding in cases of trauma, such as:
    • Taking anticoagulants
    • Having a bleeding disorder ( hemophilia )
  • Participation in certain sports (eg, football)
  • Bandages or casts that are worn too tightly or worn for too long
  • Recent injury to the area

Tell your doctor if you have any of these risk factors.

Symptoms

If you have any of these symptoms, do not assume it is due to ACS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Excruciating pain (but out of proportion to injury)
  • Feeling of tightness or fullness of muscles
  • Swollen, shiny skin over affected area
  • Sensation problems

Symptoms can develop within 30 minutes to two hours. In other cases, it may take days. ACS is an emergency. Get help right away. Damage can result in serious injury or even death.

Diagnosis

Your doctor will ask about your symptoms and medical history. She will also do a physical exam. Tests may include:

  • Tests to measure pressure inside the compartments (eg, slit catheter, tonometer)
  • Near-infrared spectroscopy (NIRS)—a test to measure the amount of oxygen in a tissue
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
  • Reflex testing—to measure impairment
  • Range-of-motion testing
  • Other tests to identify what compartment is affected
  • Lab tests to determine the extent of damage, such as:
    • Basic metabolic panel (BMP)—to assess the health of main body functions
    • Comprehensive metabolic panel (CMP)—to evaluate organ functions
    • Complete blood count (CBC)—to analyze the presence of various cells and substances found in the blood

Treatment

Surgery to relieve pressure, called fasciotomy, must be done right away to prevent permanent damage. The doctor makes a long slice into the fascia to open the envelope of tissue and relieve pressure.

Prevention

ACS is difficult to prevent because there are many causes. But there are some steps you can take to reduce your risk of injury, such as:

  • Wearing proper equipment when playing sports
  • Ensuring your medical records mention use of anticoagulants or blood diseases
  • Being aware of the risk of ACS when you are wearing a bandage or cast