Compartment syndrome refers to the swelling of muscles in groups surrounded by tissue called the fascia. These muscle groups can cause severe complications if they swell too much because the fascia doesn’t stretch, so it contains the swelling and puts pressure on the muscles, nerves, and blood vessels. There are two types of compartment syndrome: acute and chronic. One can be managed, while the other requires an immediate visit to the emergency room. The muscle groups in particular are usually in the arms or legs.

Acute Compartment Syndrome

Major trauma or other medical emergencies can result in acute compartment syndrome, during which the muscles swell rapidly in the fascia. This can happen with bone fractures or even severely bruised muscles called by impact, such as during a car accident. It can also be caused by a cast or splint put on too tight. If that’s the case, removing that cast quickly can alleviate the compartment syndrome and remove the need for surgery. But for traumatic injuries, surgeries likely will be required. 

Because the muscles can only swell so much before they hit the fascia, they begin to cut off circulation and nerve usage. This can lead to parts of the muscle dying, a condition called necrosis. Once the tissue is dead, it cannot be saved and must be removed. That is why immediate surgery is required for acute compartment syndrome. The patient should visit the emergency room right away. 

Symptoms of acute compartment syndrome include:

• Sudden intense pain in the muscle that worses with movement
• Burning in the skin
• Muscle tightness
• Numbness

Chronic Compartment Syndrome

Chronic compartment syndrome is often found in athletes and is an injury caused by overuse of a group of muscles. It most often affects the quads and calves in the legs. The swelling is less severe than acute compartment syndrome. Lessening the activity that causes the swelling can allow the muscles to heal and the swelling to subside. If it doesn’t work, however, the patient may need surgery to recover. 

Symptoms of chronic compartment syndrome include: 

• Numbness
• Swelling of the muscle that doesn’t go away
• Limited range of motion in the leg or foot

Treatment and Recovery

The surgery is called a fasciotomy. The surgeon will make an incision and cut open the fascia, which will allow the muscle to swell without causing additional damage. The muscle will then be given time to heal and return to normal. The wound is closed slowly as the swelling goes down. 

Recovering time can vary, depending on the size of the wound and the length of time it takes for the swelling to go down. The patient likely will be in a splint or on crutches for 9-12 weeks. Full recovery can take an average of 3-4 months. Physical therapy may be needed to return range of motion and to learn how to exercise properly without allowing the swelling to return. 

If you suspect compartment syndrome, contact Princeton Orthopaedic Associates as soon as possible.