Compartment syndrome can happen in any large muscular group within the body. However, it is most associated with the upper and lower extremities. Compartment syndrome occurs when swelling associated with muscle damage causes pressure within the tight sleeve of tissue that confines a muscle (the compartment). It results in insufficient blood supply to the tissue in that area.

Symptoms associated with compartment syndrome include 

• Swelling in a limb after an injury or when blood flow has been interrupted and restored
• Pain in the calf or shin after a long period of running or walking
• Significant tenderness of leg muscles

There are two types of compartment syndrome, acute and chronic.  

• Acute compartment syndrome is typically a surgical emergency arising from either an injury, such as a car crash, or when blood flow to a limb has been interrupted and then returned to normal, such as during surgery. The sudden increase in blood flow causes swelling that puts the nerves and muscles at risk of dying. 
• Chronic compartment syndrome usually occurs in people who are exercising a great deal. After swimming, biking, running, or weightlifting, the muscles of the calf and shin become very painful to the point the person has to stop before they normally would. In addition, the patient will have significant leg muscle tenderness.   

Talk to a Doctor

Active patients with unexplained calf and shin pain with exertion, especially if the muscles are tender to touch, should be evaluated for chronic compartment syndrome.

Role of Vascular Surgeon

Anyone who has been told they have a limb threatening clot in an extremity should immediately seek a referral to a vascular surgeon. In one procedure, a vascular surgeon can both restore blood flow to the limb and release the compartment with a procedure called fasciotomy. Other doctors that may offer to remove clot but are not trained to perform the fasciotomy and thus a limb threatening delay in treatment may occur. 

Diagnosis

Compartment syndrome can be a challenging diagnosis to make for both the acute and chronic forms. An accurate diagnosis requires a careful evaluation of the patient’s symptoms and examination of the affected extremity.

For the acute form, time is of the essence and if there is uncertainty the vascular surgeon may place a needle into the compartment of the extremity to measure the compartment pressure. If it is elevated, then a fasciotomy may be necessary. However, most of the time the vascular surgeon can make the diagnosis without this step and will recommend a fasciotomy.

For chronic compartment syndrome the vascular surgeon may order a CT scan, MRI scan or vascular doppler ultrasound as part of the evaluation.

Fasciotomy

The specifics of the fasciotomy procedure can vary depending on the location and severity of the compartment syndrome: 

• Incisions: The surgeon makes one or more incisions in the skin over the affected compartment. For acute compartment syndrome, long incisions may be required to adequately decompress the area. 
• Fascia Opening: The fascia is then cut open to relieve the pressure. The muscle bulges through the opening, indicating that the pressure has been relieved. 
• Monitoring and Closure: In cases of acute compartment syndrome, the wound might initially be left open (covered with a sterile dressing) to allow for continued swelling and to prevent re-accumulation of pressure. The skin can often be closed in a subsequent surgery, sometimes requiring skin grafts if the area cannot be closed directly due to swelling. In chronic compartment syndrome the incision is closed immediately. 

Nonsurgical Treatment 

For chronic compartment syndrome the vascular surgeon may recommend avoidance or discontinuation of the inciting activity if possible.