• Robin R Varghese, PT.

What is compartment syndrome? Are you suffering from pressure variation within your muscle sheath?

The muscles in our body are covered by a thin fascia, which puts them in compartments. Any external or internal reasons can increase the intra compartmental pressure and is called as Compartmental Syndrome.

Mechanism

Any injury causes bleeding or swelling within. This increases the pressure within the fascia. The normal compartment Pressure is 8 to 10 mmHg If the pressure rises up to 30 mmHg, the vessels will be compressed, resulting in pain and a decrease in blood flow. This causes Acute Compartment Syndrome.

If it is more than 15 mm Hg at rest, 20 mmHg 1 min post Exercise and 30 mmHg 5 mins post Exercise, it leads to Chronic Compartment Syndrome.

The blood circulation within these compartments get affected when there is a disturbance in the flow from the arteries to veins. More fluid oozes into the intracellular spaces. This

compromises the blood circulation to the muscle. Lack of blood circulation and nutrients affect the muscle function and leads to Ischemia and eventually Necrosis.

The anterior compartment of the leg is the most common location for compartment syndrome. Other locations in which acute compartment syndrome is seen include the forearm, thigh, buttock, shoulder, hand, and foot.

Types

Acute Compartment Syndrome (ACS)

This is a medical emergency requiring a surgery. Permanent muscle and nerve damage can occur after8 hours of injury

Chronic Compartment Syndrome (CCS).

This happens when the muscle volume increases after prolonged activity. The blood vessels get occluded, Yet not a medical emergency. It is also known as Chronic Exertional Compartment Syndrome (CECS) Eg. Anterior compartment syndrome, anterior tibial pain, recurrent compartment syndrome and idiopathic compartment syndrome.

Causes

burns

vascular injuries

crush injuries

drug overdoses

reperfusion injuries

thrombosis

bleeding disorders

infections

improperly placed casts or splints

tight circumferential bandages

penetrating trauma

intense athletic activity

and poor positioning during surgery.

Symptoms

Pain on palpation of involved muscles

Pain with passive stretching of muscles

The feeling of firmness of involved compartments

Muscle herniation can be palpated in 40-60% of patients with compartment syndrome (Usually palpated over anterior tibia)

Gait analysis may show excessive overpronation

A neurological exam may show weakness and numbness of the affected compartment

Remember the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessness


Management

Fasciotomy is the surgical management. After a fasciotomy is performed and swelling dissipates, a skin graft is commonly used for incision closure.


Physical therapy management

Rest and Cross training exercises have been found to be effective for CECS

Functional Manual Therapy (FMT) for intra and inter tissue mobility

FMT with deep tissue mobilization (DTM) along with active isometric muscle work helps in muscle contraction with movement

Stretching exercises

Scar tissue mobilization

Mobility exercises

Neural mobilization

Strength training


We at Valley Healing Hands, Brownsville, Texas Provide the best Physical therapy Treatment for all types of compartment syndromes and we are proud of our skilled physical therapists, who will be your right guide and support throughout you journey with us. Check out what our patients has to say about us and Reach out to us for an evaluation. Patients love our services, You will too!





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