De what is it?
Muscles are generally grouped according to their function, for example the flexor muscles or the extensor muscles of a limb. This group of muscles is surrounded by a thin envelope called an “aponeurosis”. We call this set a muscle compartment or compartment. The fascia is rather rigid and not very elastic. If the pressure in the compartment increases, the blood supply to the muscles may be cut off. Compartment syndrome refers to all the complaints associated with it. If the complaints are not treated, nerves and even muscles can atrophy.
This syndrome can appear suddenly (acute form) or over a prolonged period (chronic form):
- The acute form is usually caused by direct trauma such as a fracture, blow, burns, vascular damage from injury or surgery, and persistent pressure on a limb, such as in a person in a coma or when we wear too tight a cast;
- The chronic form occurs especially in people who practice intense sports. With training, muscle mass sometimes grows so quickly that it does not have enough room in the compartment. During sporting effort, the pressure increases in the muscle compartment, causing compression of the blood vessels.
How to recognize it?
It is especially the muscles of the forearm and leg (calf) that are susceptible to compartment syndrome.
An accident is often the cause of an acute form of the syndrome. The presence of 5 elements is characteristic of the pathology, namely:
- Spontaneous pain in the forearm or lower leg;
- Pain when stretching the affected muscle;
- Loss of muscle strength (paresis);
- Tingling and / or feeling of electric current passing through the limb (paraesthesia);
- No pulse in the forearm or on the back of the foot.
Locally, the muscle group can be hard and swollen. Occasionally, discoloration can also develop. The problem is that often these symptoms do not all occur at the same time. Sometimes pain is the only apparent complaint. It is then important to identify the pathology. Moreover, after an accident or an intervention these symptoms are generally not noticed immediately; there are indeed often other major injuries that can mask them.
In the case of chronic syndrome, the main complaint is also pain, especially during sports activities, which disappears with rest. The muscle may remain tender on palpation for some time. The decrease in strength due to nerve compression may cause the leg to be unable to lift the foot normally. When walking, it falls to the ground each time with a click, this is called the “stepping”
How is the diagnosis made?
Diagnosis is often difficult. The doctor must be particularly vigilant and think of compartment syndrome in the event of a serious injury of the forearm or the lower part of the leg.
In case of acute compartment syndrome, the diagnosis must be made quickly (in the first hours). Blood tests seldom provide more clarity, since muscle damage due to an accident, intervention or intensive sport practice in itself already gives abnormal results. Radiological examinations are also unnecessary. The doctor should identify the condition based on the complaints (if they exist) and signs of the disease.
In case of chronic syndrome, the doctor may refer you to a specialist to measure the pressure in the affected compartment.
What can you do ?
If you have chronic compartment syndrome, you should temporarily limit your sports training. Treatment involves allowing the muscles to rest and be less strained. This does not necessarily mean that you have to stop the sport altogether. For example, you can stop running, but continue walking, swimming, or cycling.
Sometimes you will be prescribed anti-inflammatory drugs, but since the problem is more the pinching than the inflammation, they are often unnecessary. The same goes for painkillers.
If the complaints persist for months, it will be necessary to stop the sports activities causing the complaints or to go through surgical treatment.
What can your doctor do?
A procedure is planned in which the fascia surrounding the affected muscles is cut lengthwise. In acute syndrome, the incision is left open and not sewn up until afterwards, sometimes even with a skin graft. This procedure is performed as quickly as possible (in the first few hours) to save the muscles. In case of chronic syndrome, the doctor immediately sews up the surgical incision. There follows a period of revalidation with gradual resumption of sports activities.