Compartment Syndrome

Compartment syndrome is a painful condition that occurs when pressure within the muscles builds
to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and
oxygen from reaching nerve and muscle cells. Though this condition can occur in many areas of
the body, this article will focus on compartment syndrome in the lower leg.

Compartment syndrome can be either acute (having severe symptoms for a short period of time)
or chronic (long-lasting).

• Acute compartment syndrome is a medical emergency. It is usually caused by a

severe injury and is extremely painful. Without treatment, it can lead to permanent
muscle damage.
• Chronic compartment syndrome, also known as exertional compartment
syndrome, is usually not a medical emergency. It is most often caused by athletic
exertion and is reversible with rest.

Description

Compartment syndrome develops when swelling or bleeding occurs within a compartment.

Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves,
and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted. Without a
steady supply of oxygen and nutrients, nerve and muscle cells can be damaged.

In acute compartment syndrome, unless the pressure is relieved quickly, permanent disability and
tissue death may result. This does not usually happen in chronic (exertional) compartment
syndrome.

Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg
(calf). It can also occur in other compartments in the leg, including the thigh, as well as in the
arms, hands, feet, and buttocks.

Cause

Acute Compartment Syndrome

Acute compartment syndrome usually develops after a severe injury, such as a car accident or a
broken bone. Rarely, it develops after a relatively minor injury.

Conditions that may bring on acute compartment syndrome include:

• A fracture.
• A badly bruised muscle. This type of injury can occur when a motorcycle falls on
the leg of the rider, or a football player is hit in the leg by another player's helmet. It
can also happen after overly vigorous exercise that causes muscle tissue to break
down (rhabdomyolysis)
• Reestablished blood flow after blocked circulation. This may occur after a surgeon
repairs a damaged blood vessel that has been blocked for several hours. A blood
 vessel can also be blocked during sleep. Lying for too long in a position that blocks
a blood vessel, then moving or waking up can cause this condition. Most healthy
people will naturally move when blood flow to a limb is blocked during sleep. The
development of compartment syndrome in this manner usually occurs in people
whose brain function is impaired. This can happen after severe intoxication with
alcohol or other drugs.
• Crush injuries.
• Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.
• Constricting bandages. Casts and tight bandages may lead to compartment
syndrome. If symptoms of compartment syndrome develop, remove or loosen any
constricting bandages. If you have a cast, contact your doctor immediately.
Chronic (Exertional) Compartment Syndrome
The pain and swelling of chronic compartment syndrome is caused by exercise. People who
participate in activities with repetitive motions, such as running or marching, are more likely to
develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise,
and is usually not dangerous.

Symptoms

Acute Compartment Syndrome

The classic sign of acute compartment syndrome is severe pain, especially when the muscle within
the compartment is stretched.
• The pain is more intense than what would be expected from the injury itself. Using
or stretching the involved muscles increases the pain.
• There may also be tingling or burning sensations (paresthesia) in the skin.
• The muscle may feel tight or full.
• Numbness or paralysis are late signs of compartment syndrome. This usually
indicates permanent tissue injury.
Chronic (Exertional) Compartment Syndrome
Chronic compartment syndrome causes pain or cramping during exercise. This pain goes away
when activity stops. It most often occurs in the leg.

Symptoms may also include:

• Numbness
• Difficulty moving the foot, sometimes with a sense of the foot slapping downward
when running
• Visible muscle bulging
 Volkmann's Ischemic Contracture
Definition
Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the
muscles of the forearm. The condition is also called Volkmann ischemic contracture.

Alternative Names
Ischemic contracture - Volkmann; Compartment syndrome - Volkmann ischemic contracture

Causes
Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm.
This occurs when there is increased pressure due to swelling, a condition
called compartment syndrome.

Injury to the arm, including a crush injury or fracture, can lead to swelling that presses on
blood vessels and decreases blood flow to the arm. A prolonged decrease in blood flow
injures the nerves and muscles, causing them to become stiff (scarred) and shortened.

When the muscle shortens, it pulls on the joint at the end of the muscle just as it would if it
were normally contracted. But because it is stiff, the joint remains bent and stuck. This
condition is called a contracture.

In Volkmann contracture, the muscles of the forearm are severely injured. This leads to
contracture deformities of the fingers, hand, and wrist.

There are three levels of severity in Volkmann contracture:

• Mild -- contracture of 2 or 3 fingers only, with no or limited loss of feeling

• Moderate -- all fingers are bent (flexed) and the thumb is stuck in the palm; the wrist may
be bent stuck, and there is usually loss of some feeling in the hand

• Severe -- all muscles in the forearm that both flex and extend the wrist and fingers are
involved; this is a severely disabling condition. There is minimal movement of the fingers
and wrist.
 Conditions that can cause increased pressure in the forearm include:
• Animal bites

• A forearm fracture

• Bleeding disorders

• Burns

• Injection of certain medicines into the forearm

• Injury of the blood vessels in the forearm

• Surgery on the forearm

• Excessive exercise -- this would not cause severe contractures

Symptoms
Symptoms of Volkmann contracture affect the forearm, wrist, and hand. Symptoms may
include:
• Decreased sensation

• Paleness of the skin

• Muscle weakness and loss (atrophy)

• Deformity of the wrist, hand, and fingers that causes the hand to have a claw-like
appearance

Exams and Tests

The health care provider will perform a physical exam, focusing on the affected arm. If the
provider suspects Volkmann contracture, detailed questions will be asked about past injury
or conditions that affected the arm.

Tests that may be done include:

• X-ray of the arm

• Tests of the muscles and nerves to check their function

Treatment
 The goal of treatment is to help people regain some or full use of the arm and hand.
Treatment depends on the severity of the contracture:
• For mild contracture, muscle stretching exercises and splinting the affected fingers may
be done. Surgery may be needed to make the tendons longer.

• For moderate contracture, surgery is done to repair the muscles, tendons, and nerves. If
needed, the arm bones are shortened.

• For severe contracture, surgery is done to remove muscles, tendons, or nerves that are
thickened, scarred, or dead. These are replaced by muscles, tendons, or nerves
transferred from other body areas. Tendons that are still working may need to be made
longer.

Outlook (Prognosis)
How well a person does depends on the severity and stage of disease at the time treatment
is started.

Outcome is usually good for people with mild contracture. They may regain normal function
of their arm and hand. People with moderate or severe contracture who need major surgery
may not regain full function.

Possible Complications
Untreated, Volkmann contracture results in partial or complete loss of function of the arm
and hand.

When to Contact a Medical

Professional
Contact your provider right away if you have had an injury to your elbow or forearm and
have developed swelling, numbness, and pain keeps getting worse.