Severe pain is the classical symptom of compartment syndrome. The pain usually does not respond to over the counter medications. In addition, in severe cases, compartment syndrome may present with the following signs and symptoms [7]:

• Weakness
• Pain that gradually gets worse
• Development of parasthesia in the affected area
• Skin of the affected area turns pale
• Experiencing great difficulty in moving the affected area
• Experiencing severe pain when the affected area is stretched or pulled

• Pallor

  Do not wait for the development of pallor, absence of pulse or paralysis to consult surgery. These are late findings that may only arise once the limb is non-salvageable. [coreem.net]

  Poikilothermia, paralysis, pallor, and pulselessness = late findings indicative of complete ischemia and poor prognosis. 4 Evaluation: Assess ABCs and obtain VS. [emdocs.net]

  When assessing for neurovascular integrity, remember the five Ps: pallor, pain, pulse, paralysis and paraesthesia. Pallor Pallor is a good indicator of whether the extremity is being perfused, distal to the cast or injury. [ausmed.com]

  […] extreme pain out of proportion to the injury, - pain on passive ROM of the fingers or toes (stretch pain of the involved compartment): - patient will usually hold injured part in a position of flexion to maximally relax the fascia and reduce pain; - pallor [wheelessonline.com]

  The classic signs are the five p’s – pulselessness, pallor, paralysis, paresthesia, and pain (often out of proportion to the clinical situation) By the time a patient is experiencing the 6 P’s, the risk of morbidity after fasciotomy is already very high [openanesthesia.org]

• Falling

  compartmental pressure slowly falls to normal following cessation of exercise. Pathogenesis of Compartment Syndrome Physical Exam Pain out of proportion to the injury. [orthopaedicsone.com]

  An 89-year-old woman presented after blunt injury to the left orbit from a fall. Examination findings were suggestive of left-sided orbital compartment syndrome, unresponsive to emergent lateral canthotomy and cantholysis. [ncbi.nlm.nih.gov]

• Inflammation

  Level of C-reactive protein (a protein that circulates in the blood and dramatically increases in level when there is inflammation) Inflammation is usually present if the ESR and C-reactive protein level are increased. [merck.com]

  After an injury, blood or edema (fluid resulting from inflammation or injury) may accumulate in the compartment. [webmd.com]

  Altering or ceasing activity may allow the muscle inflammation to subside, but if this does not work, a fasciotomy may be required. [hss.edu]

  If surgery is not warranted, the doctor may advise avoiding the activities that cause the condition, icing and elevation of the limb, the use of aspirin or ibuprofen to relieve inflammation and wearing shoes with a cushioned sole in them. [websites.sportstg.com]

  Ice Packs are essential to help reduce swelling and inflammation following surgery and Calf Guards may be useful to compress the lower leg further reduce swelling. [physioroom.com]

• Fever

  A 44-year-old woman was admitted to our hospital with dengue fever. She developed a haematoma in the right arm at the site of a previous arterial line insertion. [ncbi.nlm.nih.gov]

  Surgery may also be needed for people with persistent fever and weight loss. [merck.com]

  Contact a doctor if the cast gives off an odor or if a fever develops. These symptoms may indicate an infection. Contact a doctor if the cast causes worsening pain or new numbness or weakness. These symptoms may indicate compartment syndrome. [msdmanuals.com]

• Poikilothermia

  Poikilothermia, paralysis, pallor, and pulselessness = late findings indicative of complete ischemia and poor prognosis. 4 Evaluation: Assess ABCs and obtain VS. [emdocs.net]

  Poikilothermia Difference in the injured area’s warmth compared to the contralateral location. If the affected area feels cooler than the unaffected area, then this would suggest that the area cannot thermoregulate and has vascular compromise. [pedemmorsels.com]

  Historically, the mnemonic memory device for compartment syndrome is the "5 Ps" (pain, paresthesia [change in sensation], pallor [pale coloration], paralysis, and poikilothermia [inability to control temperature]; some authors include pulselessness), [medicinenet.com]

• Respiratory Distress

  distress syndrome ( J80 ) complications occurring during or following medical procedures ( T80-T88 ) complications of surgical and medical care NEC ( T80-T88 ) newborn respiratory distress syndrome ( P22.0 ) Certain early complications of trauma, not [icd10data.com]

  Gattinoni L, Pelosi P, Suter PM et al (1998) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndrome? Am J Respir Crit Care 158:3–11 Google Scholar 21. [link.springer.com]

• Abdominal Distension

  A 31-year-old male patient with chronic constipation of unknown aetiology presented emergently with worsening nausea, vomiting and abdominal distension of one week duration. On examination, his abdomen was distended with minimal tenderness. [ncbi.nlm.nih.gov]

• Hypotension

  […] function is impaired & necrosis of soft tissues eventually develops; - intracompartmental pressure: - necrosis of tissue may begin at interstitial pressure as low as 30 mm - while others have suggested that it begins at higher level; - w/ periods of hypotension [wheelessonline.com]

  Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. [ncbi.nlm.nih.gov]

  Hypotension potentiates compartment syndrome Investigation usually not necessary as compartment syndrome is a clinical diagnosis in children or unconscious patients where clinical exam is unreliable, compartment pressure monitoring with catheter, AFTER [orthopaedicsone.com]

• Vascular Disease

  Peripheral vascular disease/ischaemic limb These are included together as they are part of a spectrum of disease. [oxfordmedicaleducation.com]

  023406, 泌尿器疾患, ﾋﾆｮｳｷｼｯｶﾝ, urologic disease, 039784, 病気, ﾋﾞｮｳｷ, disease, 017213, *, 症状, ｼｮｳｼﾞｮｳ, symptom, 040039, 損傷, ｿﾝｼｮｳ, damage and injury, 046467, 血管疾患, ｹｯｶﾝｼｯｶﾝ, vascular disease, 040158, 心血管疾患, ｼﾝｹｯｶﾝｼｯｶﾝ, cardiovascular disease, 023404, 外科術, [togodb.biosciencedbc.jp]

  The true incidence of cases associated with vascular trauma may not be known because many vascular surgeons perform a prophylactic fasciotomy at the time of the vascular repair in high-risk patients. [emedicine.com]

• Leg Pain

  Leg pain or cramps at night was reported by 24% of the respondents. Age, rheumatic disease, use of hormone medication, heart failure, leg oedema, and peripheral arterial disease were all significantly associated with leg pain or cramps (P 15mmHg. [ncbi.nlm.nih.gov]

  […] compartment syndrome fasciotomy leg pain EICS, exercise induced compartment syndrome Recurrent leg pain is a common problem in very active people. [doi.org]

• Muscle Weakness

  Complications Complications include: inability to return to previous performance levels; continued muscle weakness; recurrence of symptoms. These may be amenable to further surgery but this may not alter muscle strength. [sportsinjurybulletin.com]

  An exercises programme is given to improve muscle weakness and to stimulate proprioceptive sensors. Soft tissue massage [10] may be used to provide lymphatic drainage. [physio-pedia.com]

  Severe pain during exercise that typically goes away an hour after stopping Pain on both sides of the body, such as in both legs Fullness or tightness in the muscle Tender, aching muscles Muscle weakness Numbness, tingling In severe cases, foot drop—a [uvahealth.com]

  Symptoms may include: Severe pain during exercise that typically goes away an hour after stopping Pain on both sides of the body, such as in both legs Fullness or tightness in the muscle Tender, aching muscles Muscle weakness Numbness, tingling In severe [cancercarewny.com]

  Nerve and muscle dysfunction within the affected compartment causes muscle weakness, numbness or tingling, and an abnormal gait. [patient.info]

• Calf Pain

  CASE: A 15-year-old female competitive high school basketball player presented as an outpatient with a 3-month history of bilateral exertional calf pain. [ncbi.nlm.nih.gov]

  Pain Shin Pain Achilles Injuries Achilles Tendonitis / Tendinitis Achilles Tendon Rupture Retrocalcaneal Bursitis Calf Pain Calf Muscle Tear Shin Pain Shin Splints Stress Fracture Tibialis Posterior Tendinopathy Muscle Injuries Compartment Syndrome Muscle [physioworks.com.au]

  Clinical diagnosis is hard because patients usually present with 1 of these signs and the rest when it is “too late” 6ps : PAIN, Pallor, Pulselessness, Paresthesias, Paralysis, Perishingly cold/Pudgy calf Pain is the earliest sign/ Pain w/ passive stretching [sinaiem.org]

• Muscle Tenderness

  Severe pain during exercise that typically goes away an hour after stopping Pain on both sides of the body, such as in both legs Fullness or tightness in the muscle Tender, aching muscles Muscle weakness Numbness, tingling In severe cases, foot drop—a [uvahealth.com]

  Symptoms may include: Severe pain during exercise that typically goes away an hour after stopping Pain on both sides of the body, such as in both legs Fullness or tightness in the muscle Tender, aching muscles Muscle weakness Numbness, tingling In severe [cancercarewny.com]

  Muscle tenderness and swelling. Excessive pain on passive movement, increasing pain despite immobilisation. Peripheral pulses may still be present. [patient.info]

• Myalgia

  However, CCS patients may instead experience both increased leg pain and a proximal myalgia, which is possibly a referred pain. [ncbi.nlm.nih.gov]

  Finnish verenvuodon aiheuttama lihasaitio- oireyhtymä English compartment syndrome secondary to a bleeding Last Update: 2017-04-26 Usage Frequency: 2 Quality: Finnish yleinen: lihasaitio-oireyhtymä, lihassärky English common: compartment syndrome, myalgia [mymemory.translated.net]

• Fear

  Kids may be reluctant to be examined – either fear more pain or just fear your funny looking face. Kids may not understand how to describe the altered sensation that they have … even older teenagers might not be able to convey “parethesias.” [pedemmorsels.com]

  Compartment Syndrome is something all juniors live in fear of, but actually, it’s pretty simple! The bottom line is, if you’re worried or it is playing in the back of your mind, ask your registrar to come take a look. [geekymedics.com]

• Paresthesia

  He notes the development of right hand paresthesias during transport. Triage VS: BP 138/91, HR 110, T 99.1 Oral, RR 12, SpO2 99% on room air. [emdocs.net]

  The probability of compartment syndrome in the patient presenting with pain, paresthesias, paresis, and pain with passive stretch, all of which were positive findings in this patient, has been reported to be 98%. [ncbi.nlm.nih.gov]

  Pain with passive stretching, or paresthesia can be early signs of compartment syndrome. [openanesthesia.org]

• Burning Sensation

  After admission to inpatient rehabilitation, the patient complained of pain, burning sensation, and numbness in the distal right lower limb. [ncbi.nlm.nih.gov]

  A tingling or burning sensation (paresthesias) in the muscle may be present. Numbness or paralysis in the limb may signal that cell death has begun and it may be difficult to restore function. [websites.sportstg.com]

  You may feel a burning sensation or a tightness around the affected area. Pins and needles can also occur in the arm or leg affected by compartment syndrome. You may also have reduced sensation when the skin on the affected limb is touched. [patient.info]

  There may also be tingling or burning sensations (paresthesias) in the skin. The muscle may feel tight or full. Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury. [orthoinfo.org]

• Peripheral Neuropathy

  Finally, the findings of muscle atrophy and/or peripheral neuropathy are not consistent with CECS. [consultant360.com]

  A broad differential diagnoses at this point included peripheral nerve entrapment, peripheral neuropathy, motor neuron pathologies, and muscular disorders. [sportsmedicine-open.springeropen.com]

• Sciatica

  Fracture Tibialis Posterior Tendinopathy Muscle Injuries Compartment Syndrome Muscle Strain Cramps DOMS - Delayed Onset Muscle Soreness Overuse Injuries Systemic Conditions Rheumatoid Arthritis Fibromyalgia Psoriatic Arthritis Lupus Neurological Conditions Sciatica [physioworks.com.au]

• Stroke

  [Extra] minutes mean muscle and nerve damage, just the way when you’re treating a stroke, extra minutes mean more damaged brain cells or, in the case of a heart attack, damaged heart muscle. [scientificamerican.com]

In majority of the cases, physical examination of the signs and symptoms would be enough to diagnose the condition. No kind of laboratory workup is indicated. In physical examination, the pressure in the compartment is directly measured with the help of needle that is attached to pressuremeter. The pressure in the compartment is measured before and after the activity [8].

In case of acute compartment syndrome with associated trauma physical examination along with the following analysis becomes necessary:

• Renal function analysis
• Urinalysis
• Creatine phosphokinase
• Urine myoglobin
• Concentration of creatine phosphokinase of about 1000 to 5000 U/mL suggests the onset of compartment syndrome. 

For acute compartment syndrome, surgery is the only available option to treat the condition. In this method, long incisions are made in the affected area to release the pressure. The wounds are usually covered with a sterile bandage and are closed in a second surgical procedure [9].

In case of any bandage or cast that is causing the condition, it should be loosened to relieve the pressure. Medications such as opioids and NSAIDs can be administered for providing relief from pain [10]. It is advised that side effects of the medications should be considered before prescribing to patients.

Prognosis of the condition largely depends on when the condition was diagnosed and when was the treatment initiated. In a research study, it has been reported that complete restoration of limb function could be attained when fasciotomy was carried out within 6 hours of injury [6]. When the treatment is not initiated within 12 to 24 hours of compression, then permanent damage to the nerve and muscles can occur.

Development of excessive pressure inside a muscle compartment causes compartment syndrome. There are several factors that lead to increase in the pressure; these include: Fractures, injuries, infections, development of muscular hypertrophy, prolonged limb compression and burns causing development of acute compartment syndrome.

Chronic compartment syndrome is a common phenomenon for athletes and occurs due to repetitive movements or activities such as running, exercising, cycling and playing sports. All these can cause pressure inside the muscle to increase causing pain and tightness in the affected areas [2].

The exact prevalence of compartment syndrome is not known. It has been reported that patients who have suffered vascular injury are more prone to develop compartment syndrome. It has been estimated that about 19% patients with vascular injury required fasciotomy to treat acute compartment syndrome [3]. In a study of military personnel of United States, it has been reported that about 4100 cases of chronic form of compartment syndrome occurred between the years 2006 to 2011 [4].

Muscles of the arms and legs are separated by thick layers of tissue known as fascia. Each individual layer of fascia consists of a confined space known as the compartment. This compartment contains muscle nerves, blood vessels and tissues. All these are closely covered by the fascia. It is necessary to understand that there is no way through which fascia can expand.

As a result when pressure builds up inside a compartment, the muscles, nerves and blood vessels are compressed. When the pressure increases beyond limits, the blood flow is restricted causing permanent damage to the nerves and muscles. In such cases, if treatment is not initiated on time then the muscles unable to bear any more pressure undergo atrophy. As a result amputation of the affected limb would be the only available alternative [5].

So far no guidelines have been given to prevent the development of compartment syndrome. However, with early diagnosis and prompt initiation of treatment the onset of complications can certainly be prevented.

Individuals with casts should be told in advance about the swelling that can develop. If such patients experience pain under the cast, then they should immediately seek medical advice.

Decrease in the blood flow due to pressure buildup in a muscle compartment limits the supply of oxygen and nutrition to the nerves and the muscle cells. Timely initiation of treatment is necessary; failure to do can cause incapacitating complications to set in. Compartment syndrome can be acute and chronic in nature. Acute form of compartment syndrome is a medical emergency requiring prompt treatment. On the other hand, the chronic form is less severe and is also known as exertional compartment syndrome [1].

Definition

Compartment syndrome is described as excessive increase in the pressure within a muscle compartment. The consequent buildup of pressure in the compartment can call for restricted blood flow which in turn can cause muscles and nerve damage. Compartment syndrome can be acute or chronic in nature.

Cause

The cause of pressure buildup within the muscles can be attributed to trauma resulting from injury or accidents. Chronic compartment syndrome is more common among athletes and occurs due to repetitive activities and carrying out heavy exercises. In such cases, the pressure increases in the compartment only during such activities. The body parts most commonly affected by this condition include the forearm and the lower leg. However, in some instances it can also affect the thigh, upper arm, hand and foot.

Symptoms

One of the most classical symptoms of compartment syndrome includes development of severe pain in the affected area that gets worse and does not fade away with medications. In addition, individuals also experience feeling of numbness, burning or tingling sensation in the affected area. It also becomes difficult to remove the part of the limb that is affected.

Diagnosis

In most cases physical examination is enough to diagnose the condition. However, many a times analyzing the creatine phosphokinase levels and evaluating kidney functioning is also required.

Treatment

Surgery is often the method of choice to treat compartment syndrome. It is employed to prevent permanent damage to the affected area. Pain relieving medications are also administered depending on the patient’s profile.

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3. Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. Jan 1976;58(1):112-5.
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