We are not robots (as far as I know) but our bodies are nevertheless made up of compartments – muscles, nerves, and organs are bundled into sections in our body by thin sheets of connective tissue called fascia. The fascia, in effect, helps keep out body systems organized. It is made of collagen, so it is flexible and pliable, but it does not expand terribly well. Consequently, when swelling develops in a compartment, the pressure builds with it. In the right circumstances, this pressure may build enough to interfere with blood flow and nerve signals within that compartment. And, without blood flow, tissues get damaged permanently. A delay in diagnosing compartment syndrome may lead to loss of function, limb loss or, in extreme cases, death.
Compartment syndrome is typically classified as either chronic or acute. Chronic compartment syndrome is a condition where symptoms develop following exercise and resolve with rest, or in some cases, physical therapy or surgery. Acute compartment syndrome (ACS) most commonly follows some form of trauma such as a fracture or crush injury. It is considered a medical emergency, apart from the underlying injury.
The symptoms of ACS are severe pain, tingling and/or numbness, and a feeling of fullness in the affected muscle tissue. The pain is difficult to control but, perversely, may decrease in the later stages of the disease. Once the condition is diagnosed, emergency treatment includes decompressing the compartment: removing any dressing or cast laid over the underlying injury, and, if still necessary, opening the skin over the injury, also known as a fasciotomy.
So, how does compartment syndrome get misdiagnosed?
If the patient’s pain dramatically worsens in the affected limb following treatment, whether surgery, casting, or otherwise wrapping, the provider must have ACS on his or her differential. If ACS is suspected, a provider may measure pressures in the muscle with portable pressure testing devices. Typically, though, an orthopedist is better qualified to diagnose and treat ACS than is an emergency physician. Accordingly, consult with an orthopedic surgeon should be the first step in addressing suspected ACS.
ACS is a time sensitive condition and prompt action is critical to relieving pressure in the limb and preventing further damage from ischemia. Timely intervention may save permanent contracture of the hand or foot, necrosis of the limb, or may save the patient’s life.
