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
vascular injuries
crush injuries
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!