Diagnosing Compartment Syndrome

Doctors at NYU Langone provide a quick and accurate diagnosis of compartment syndrome, which occurs when increased pressure inside a muscle compartment disrupts or blocks blood flow to muscles and nerves. Restricted blood flow may cause muscle and nerve tissue to weaken and die.

Muscle compartments are groups of muscles, nerves, and blood vessels wrapped in thick sheets of connective tissue called fascia. Fascia does not easily expand, so if swelling causes pressure to build within a compartment, you need treatment to alleviate the pressure.

Compartments are located in the arms, hands, feet, and legs. There are four separate muscle compartments located in the lower leg, where compartment syndrome is most commonly diagnosed.

There are two types of compartment syndrome. Acute compartment syndrome occurs as the result of an injury and requires immediate treatment. Chronic compartment syndrome occurs as the result of a repetitive activity, such as running, and doctors can usually manage it on outpatient basis.

Acute Compartment Syndrome

Acute compartment syndrome is a medical emergency and is often the result of a traumatic injury, such as a fracture; severe muscle bruises; injuries that crush part of the arm or leg; serious burns; or complications during surgery. Acute compartment syndrome can also be caused by bandages or casts that are too tight and restrict blood flow in the affected arm or leg.

Without treatment to relieve the pressure of acute compartment syndrome, muscle and nerve tissue may be cut off from their blood supply. Without oxygen and nutrients, muscles and nerves may stop functioning or die. In severe circumstances, there may be so much tissue damage that doctors need to amputate the affected limb.

If you experience significant pain, numbness or tingling, tightness in or around the muscle with excessive swelling, or notice that the skin in the affected area is pale or shiny and tight like a drum, our doctors recommend that you go to the nearest emergency room.

Chronic Compartment Syndrome

Chronic compartment syndrome, also called chronic exertional compartment syndrome, occurs as the result of intense workouts—usually high-impact exercises such as running and jumping. Exercise increases blood flow to muscles, expanding blood vessels and increasing pressure inside muscle compartments. The pressure may eventually restrict blood flow altogether, damaging the muscles and nerves.

Symptoms of chronic compartment syndrome, such as pain, tightness, cramping, and sometimes numbness, occur during exercise but usually go away when the activity is stopped. The condition is more likely to occur if intense athletic activity begins after a period of inactivity—for example, at the start of an athletic season, when workouts are rigorous but athletes may be out of practice, or after an intense ramping up of training.

Chronic compartment syndrome is not immediately dangerous, but it can become a more serious problem if not eventually addressed. Athletes who use anabolic steroids are at increased risk, because muscles may grow quickly and push against the surrounding fascia, increasing the pressure inside the muscle compartment.

In order to diagnose compartment syndrome, doctors at NYU Langone perform a physical exam and a test to measure the pressure inside the muscle compartments.

Diagnostic Tests

If your symptoms appear during and after intense exercise and no traumatic injury has occurred, there is no need to go to the hospital immediately. However, you should make an appointment with a doctor as soon as possible. Your doctor may ask you to come to the appointment after a workout so he or she can examine the muscles while you have symptoms.

Your NYU Langone doctor conducts a physical examination for non-emergency chronic compartment syndrome in his or her office. He or she examines the affected area for signs of tenderness, swelling, or tension and may ask when your symptoms appear and how long they last.

Imaging Tests

NYU Langone orthopedic specialists may also recommend imaging tests to rule out other causes of exercise-related pain that have similar symptoms. An X-ray or MRI scan, which create detailed images of the inside of the body, may reveal evidence of a stress fracture or tendinitis.

Compartment Pressure Testing   

A compartment pressure test measures the amount of pressure within the muscle compartment. To perform this test, a doctor first injects a small amount of anesthesia into the affected muscles to numb them. He or she inserts a handheld device attached to a needle into the muscle compartment to measure the amount of pressure inside the compartment. 

Doctors at NYU Langone may also use a special type of MRI to detect elevated pressure. MRI uses a magnetic field and radio waves to create computerized, three-dimensional images of structures inside the body. 

If you’ve experienced a traumatic injury and the compartment pressure test reveals that you have acute compartment syndrome, your doctor immediately performs surgery to relieve pressure in the compartment.

If symptoms point to chronic compartment syndrome, your doctor performs a compartment pressure test before and after a workout to compare pressure levels. If either or both readings indicate high pressure, you have chronic compartment syndrome. Your doctors may recommend medical treatment or surgery.

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