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Brandon Macias, Ph.D


Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow, according to the National Institutes of Health’s Medline.

Compartment syndrome results from an abnormal elevation of intramuscular pressure (IMP) and can be mild, chronic, or acute.  Most compartment syndrome cases occur in leg muscles.  Mild chronic compartment syndrome can be treated with rest and variations in an exercise schedule. Acute compartment syndrome may occur after blunt trauma for example, in an automobile accident when the driver’s leg is injured.  The increased IMP can appear immediately. It usually requires prompt treatment by a physician.  Typical symptoms include, severe and lasting pain that does not respond to pain medications, numbness, some loss of movement, reddened skin color, and swelling. 

A physician would measure IMP with a pressure sensor placed into the muscle to diagnose compartment syndrome. Intramuscular pressure is most often reported in units of mmHg; mmHg are units similar to those of blood pressure.  Normal IMP of the anterior compartment of the leg is 3mmHg at rest or up to 15mmHg after exercise.

Participants in sports or intense training exercises, especially those involving the legs, can develop chronic compartment syndrome.  Chronic compartment syndromes are often more difficult to diagnose since the affected individual does not have trauma to the muscle and is otherwise healthy.  As with the acute version, symptoms include severe, long-lasting pain and numbness.   In chronic compartment syndrome, resting IMP can be about 26mmHg at rest or 34mmHg after exercising. 

Skeletal muscle is surrounded by a dense fibrous connective tissue called fascia.  During a normal muscle contraction, the IMP within the muscle will rise because the tissue volume expands within an area restricted by the fascia.  This scenario is similar to filling a balloon with water, water continues to fill the balloon, and pressure within the balloon increases until the balloon pops.    Some individuals may be predisposed to chronic compartment syndrome due to an abnormal fascia, or it may result from overtraining.  Chronic compartment syndrome can cause painful compromised blood flow to a muscle, limit the force of contraction, and ultimately cause muscle cell damage or permanent nerve injury.  The symptom of severe pain signals most individuals to check with a physician. However, if a patient is unable to report pain due to sedation or unconsciousness, the risk of permanent injury rises.

Presently, there are few treatments for compartment syndrome other than reduced activity or surgery.  Surgery often involves the removal of the fascia layer surrounding the muscle to release the high muscle pressures and restore blood flow to the muscle.

References:

  1. RA Pedowitz, Hargens AR, Mubarak SJ, Gershuni DH, Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 18:35-40, 1990. http://www.ncbi.nlm.nih.gov/pubmed/2301689
  2. Hargens AR and Mubarak SJ. Current concepts in the pathophysiology, evaluation, and diagnosis of compartment syndrome. Hand Clin 14:371-83, 1998. http://www.ncbi.nlm.nih.gov/pubmed/9742417
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