Acute compartment syndrome results from trauma to the muscle or bone in the compartment.
This trauma leads to bleeding inside the compartment. As the blood builds up in
the compartment, with nowhere to go, the pressure increases. Because this happens
at a fairly rapid rate (sometimes within minutes, other times over a period of hours)
the pressure can build to a high level and cause serious damage to the nerves and
blood vessels.
Chronic compartment syndrome is usually the result of overuse. The muscle becomes
inflamed and swells over time and with rest returns to near normal. This causes
pressures that are high at times and this high pressure over time can cause damage
to the blood vessels and nerve tissue. The longer the pressure is elevated the more
damage results.
The Anatomy Involved With Compartment Syndrome
To better understand compartment syndrome, it's a good idea to have some knowledge
of the anatomy involved. The anterior compartment houses the tibialis anterior,
extensor digitorum longus, extensor hallicus longus, and the peroneus tertius muscles
and is bordered by the tibia and fibula. The superficial posterior compartment covers
the gastrocnemius, soleus, and plantaris muscles and is behind the tibia and fibula.
The deep posterior compartment is tucked in between the tibia and fibula and contains
the flexor digitorum longus, flexor hallicus longus, popliteus and the tibialis
posterior. Also running through this compartment are the posterior tibial artery
and vein along with the tibial nerve.
Acute compartment syndrome involves a trauma to the muscle or bone within any of
these compartments. The trauma then causes bleeding or swelling and increases the
internal pressure. Since the fascia around the muscle cannot expand enough to accommodate
the increase in size, the pressure will rise. Since there is no way for the pressure
to release it will continue to rise until the tissues are destroyed. Acute compartment
syndrome may also occur post-surgery from a blood flow blockage, or even rapid muscle
growth from anabolic steroid use.
Chronic compartment syndrome results from overuse or repetitive stresses to the
muscle inside the compartment. When a muscle is worked it becomes engorged with
blood causing it to swell. When minor trauma from overwork or repetitive stresses
causes the muscle to continue to swell it may become too large for the surrounding
fascia thereby increasing the pressure in the compartment. This pressure will begin
to diminish after the exercise is stopped, although it may stay up for some time
after.
Causes, Symptoms, Treatment and Prevention
Acute compartment syndrome occurs with trauma to the structures in the compartment.
Any of the following may be a cause;
- Fracture to the bone
- Tearing of the muscle
- Crush injury
- Blood flow blockage; due to injury or clots
- Post-surgical swelling or bleeding
- Anabolic steroid use
- Extreme increase in activity level; increases mileage or speed workouts too quickly
Chronic compartment syndrome results from repetitive trauma and overuse. The following
are possible causes:
- Running; especially on hard surfaces or a change of surface
- Use of braces, wrapping or taping that is too tight
- Muscle hypertrophy due to exercise without the accompanying fascia expansion
- Repetitive stress that results in intra-compartment pressure not returning to
normal during rest