Chronic compartment syndrome

Description

Chronic compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. Any person can develop the disease, but it is more common in young adult runners and athletes who participate in activities that involve repetitive impact.

Chronic compartment syndrome may respond to nonoperative treatment and activity modification. If nonsurgical treatment does not help, your doctor may recommend surgery. The surgery is a success for many people and it can allow you to return to your sport.

Symptoms

Their limbs have specific areas of muscle (compartments). The lower part of the leg, for example, has four compartments. Chronic compartment syndrome often occurs in the same compartment of an affected limb in both sides of the body, usually in the lower part of the leg.

Signs and symptoms may include:

  • Pain, burning or cramping pain in a compartment of the affected limb
  • Tightness in the affected limb
  • Numbness or tingling in the affected extremity
  • The weakness of the affected limb
  • Foot drop, in severe cases, if the legs are affected
  • Sometimes, swelling, or a lump as a result of a muscle hernia

The pain caused by the chronic compartment syndrome usually follow the following pattern:

  • Starts continuously after a certain time, distance, or intensity of effort after the start of the exercise of the affected limb
  • Progressively worse as the exercise
  • Becomes less intense or completely stops within 15 minutes of stopping the activity
  • With time, the recovery time after exercise can increase

Taking a complete break from exercise or realization of the unique low-impact activity that may relieve your symptoms, but relief is usually only temporary. Once you start running again, for example, those who are familiar with the symptoms generally appear again.

When to see a doctor

If you have recurrent unusual pain, swelling, weakness, loss of sensation or pain when you exercise or participate in sports activities, talk with your doctor.

Sometimes chronic compartment syndrome is confused with pain in the shins, one of the most common causes of leg pain in young people who do a lot of vigorous weight-bearing activity, such as running. If you think that you have pain in the shins, and the pain does not improve with self-care, talk with your doctor.

Causes

The cause of the chronic compartment syndrome is not fully understood. When you exercise, the muscles to expand its volume. If you have chronic compartment syndrome, the tissue that lines the affected muscle (fascia) does not expand with the muscle, causing pressure and pain in a compartment of the affected limb.

Some experts suggest that the way you move, while the exercise may have a role in the cause of the chronic compartment syndrome. Other causes can include having the muscles that extend excessively during exercise, especially inflexible of the fascia that surrounds the affected muscle compartment or have high pressure within the veins.

Risk factors

Certain factors increase the risk of developing chronic compartment syndrome, including:

  • Age. Although people of any age can develop chronic compartment syndrome, the condition is more common in male and female athletes under the age of 30 years.
  • Type of exercise. Repetitive impact activity such as running — this increases the risk of developing the condition.
  • Overtraining. Working too much or too often can also increase the risk of chronic compartment syndrome.

Complications

Chronic compartment syndrome is not a life-threatening condition and usually does not cause permanent harm if you get the right treatment. However, the pain, numbness, or weakness associated with chronic diseases by compartment syndrome may prevent you from continuing to exercise or practice your sport at the same level of intensity.

Chronic compartment syndrome

Diagnosis

Other matters related to the exercise of the most common problems in chronic compartment syndrome, so your doctor may first try to rule out other causes — such as shin splints or stress fractures — before moving on to more specialized testing.

Results of physical exams for chronic compartment syndrome are often normal. Your doctor might prefer to examine you after you've exercised to the point of lead to symptoms. Your doctor may notice a bulge, muscle, tenderness, or stiffness in the affected area.

Imaging studies

Imaging studies may include:

  • Magnetic resonance imaging (MRI).A typicalMRIscan of your legs can be used to assess the structure of the muscles in the compartments and rule out other possible causes of your symptoms. A advancedMRIscan can help you to evaluate the fluid volumes of the compartments. The images are taken at rest, while moving your foot until you feel the symptoms, and after exercise. This type of ofMRIscan has been found to be accurate in the detection of chronic compartment syndrome, and can reduce the need for the invasion of the compartment pressure testing.
  • Near-infrared spectroscopy (NIRS). near-infrared spectroscopy (NIRS) is a new technique that measures the amount of oxygen in the blood in the affected tissue. The test is performed at rest and after physical activity. This helps to determine if your muscle compartment has decreased the flow of blood.

Magnetic resonance imaging (MRI). A typical magnetic resonance imaging of their legs can be used to evaluate the structure of the muscles in the compartments and rule out other possible causes of your symptoms.

An advanced magnetic resonance imaging can help evaluate the fluid volumes of the compartments. The images are taken at rest, while moving your foot until you feel the symptoms, and after exercise. This type of magnetic resonance imaging has been found to be accurate in the detection of chronic compartment syndrome, and can reduce the need for the invasion of the compartment pressure testing.

Compartment pressure testing

If the results of the imaging studies do not show a stress fracture, or similar cause of pain, your doctor may suggest the measurement of the pressure inside the muscle compartments.

This test, often called the compartment pressure measurement is the gold standard for the diagnosis of chronic compartment syndrome. The test consists in the insertion of a needle or catheter into the muscle before and after exercise in order to make the measurements.

Because it is invasive and slightly painful, compartment pressure measurement, it is generally not performed unless the clinical history and other evidence strongly suggest that you have this condition.

Treatment

Options to treat chronic compartment syndrome include both surgical and nonsurgical approaches. However, nonsurgical measures are usually successful only if you stop or greatly reduce the activity that caused the disease.

Non-surgical options

Your doctor may initially recommend pain medications, physical therapy, sports shoe inserts (orthotics), massage or a break from exercise. Change the shape of the earth on your feet when you are jogging or running, it might also be useful. However, the non-surgical options do not usually offer long-lasting benefits to the real chronic compartment syndrome.

Injections of botulinum toxin (Botox) in the leg muscles can also help treat chronic compartment syndrome, but more research needs to be done in this treatment option. Your doctor can use anesthetic injections beforehand to help draw a map of the affected area and determine what Botox dose is needed.

Surgical options

A surgical procedure called a fasciotomy is the most effective treatment of the chronic compartment syndrome. It involves cutting open the inflexible tissues that protect each of the affected muscle compartments. This relieves the pressure.

Sometimes, a fasciotomy may be performed through small incisions, which can reduce the recovery time and allow you to return to your regular sport or activity of the afternoon.

Although surgery is effective for most people, is not without risk and, in some cases, it may not completely alleviate the symptoms associated with chronic diseases by compartment syndrome. Complications of surgery can include infection, permanent nerve damage, numbness, weakness, bruising, and scarring.

Self-care

To help relieve chronic pain for compartment syndrome, try the following:

  • The use of orthotics or wear of the best sports shoes.
  • Limit their physical activities to those that do not cause pain, particularly focusing on low-impact activities such as the bike or an elliptical trainer. For example, if you run it bothers your legs, try swimming. Or try to run on softer surfaces.
  • Stretch the painful limb after exercise.

Preparing for your appointment

It is likely to start by seeing your family doctor. He or she may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Key personal information, including what sports to participate in, the type of exercise you do, and how much and how often you exercise,
  • All medications, vitamins or supplements that you are taking, including dose
  • Questions to ask your doctor

To obtain copies of the last exams of images that you've had, if possible. Ask your personal physician how you can get these sent to your doctor before the appointment.

Have a friend or family member, if possible, to help you remember the information they give you.

For chronic compartment syndrome, questions to ask your doctor include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available, and which do you recommend?
  • I have other health conditions. How can I best manage these conditions?
  • Are there restrictions I need to follow, such as avoiding certain activities?
  • You should see a specialist? If so, who do you recommend?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you several questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • How soon after your symptoms start after the start of activity?
  • How quickly the symptoms resolved after stopping your activity?
  • How to note the weakness in the legs or feet?
  • Do you have any numbness or tingling?
Symptoms and treatment of Chronic diseases by compartment syndrome