Crash injury and compartment syndrome
Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can be the result of a crush injury and can lead to muscle and nerve damage and problems with blood flow.
Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, like insulation covering wires.
Fascias do not expand. Any swelling in a compartment will lead to increased pressure which will press on the muscles, blood vessels and nerves. If this pressure is high enough, blood flow to the compartment will be blocked, leading to the possibility of permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the limb may need to be amputated.
Compartment syndrome is most common in the lower leg and forearm and can also occur in the hand, foot, thigh, and upper arm.
The main symptom of compartment syndrome is severe pain that does not go away when you take pain medicine or raise the affected area. In more severe cases, symptoms may include:
- Decreased sensation
- Paleness of skin
- Severe pain that gets worse
A physical exam will reveal:
- Pain when the compartment is squeezed
- Severe pain when you move the affected area. For example, a person with compartment syndrome in the foot or lower leg experiences severe pain when they move their toes up and down.
- Swollen and shiny skin
To confirm the diagnosis of compartment syndrome, the health care provider will measure the pressure in the compartment. This is done by inserting a needle, attached to a pressure meter, into the compartment. Specific pressure measurements will lead to a diagnosis of compartment syndrome.
Swelling that leads to compartment syndrome occurs from trauma such as a car accident, crush injury, or surgery. Swelling can also be caused by complex fractures or soft tissue injuries due to trauma. Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running.