Chronic Compartment Syndrome: Recognising the Signs and Treatment Options

If you’re an athlete or someone who experiences recurring muscle pain, tightness, or swelling after physical activity, you may be dealing with a condition known as chronic compartment syndrome (CCS). Unlike acute compartment syndrome, which is a medical emergency, CCS is a less urgent but persistent condition that can significantly affect your performance and quality of life. In this article, we will explore the symptoms of chronic compartment syndrome, explain how it develops, and discuss both surgical and non-surgical treatment options to help you manage this condition.

What is Chronic Compartment Syndrome?

Chronic compartment syndrome occurs when pressure builds up within a muscle compartment—a group of muscles, nerves, and blood vessels surrounded by a thick tissue known as fascia. The fascia doesn’t expand, so when there’s an increase in pressure due to exercise or other activities, it can restrict blood flow and cause pain. This condition is most common in the lower legs but can also occur in the arms, hands, and other areas.

Why Does This Happen?

When you exercise, your muscles naturally swell as they fill with blood. In someone with chronic compartment syndrome, the swelling increases the pressure within the muscle compartment beyond what the body can manage, causing pain and discomfort. Over time, this can lead to muscle weakness, reduced performance, and even nerve damage if left untreated.

Recognising the Symptoms of Chronic Compartment Syndrome

The most common symptom of CCS is pain during exercise that typically subsides when you rest. However, there are other key signs to watch for:

1. Tightness or aching: The affected area may feel tight or achy, especially during or after activity.
2. Swelling: You might notice swelling in the affected muscle compartment, particularly in the legs or arms.
3. Numbness or tingling: Restricted blood flow can lead to sensations of numbness or tingling in the surrounding nerves.
4. Weakness: Over time, the muscles may become weaker, making it harder to perform everyday activities or exercises.
5. Pain that improves with rest: Pain usually starts after a specific duration or intensity of exercise and improves once you stop the activity.

It’s important to remember that CCS is different from acute compartment syndrome, which is a medical emergency that requires immediate intervention. If you experience sudden, severe pain, swelling, or loss of function in a limb, seek urgent medical help.

Treatment Options for Chronic Compartment Syndrome

There are both non-surgical and surgical treatments available for managing chronic compartment syndrome. The treatment approach largely depends on the severity of your symptoms and how much the condition affects your daily life.

Non-Surgical Treatments

1. Activity Modification: In some cases, adjusting the type or intensity of your exercise can help alleviate symptoms. Switching to lower-impact activities, like swimming or cycling, may reduce the pressure on the affected muscles.

2. Physical Therapy: A physiotherapist can help you develop a stretching and strengthening programme tailored to your needs. Specific exercises that improve flexibility and mobility may help relieve the pressure within the compartments.

3. Orthotics: In some cases, wearing orthotic devices in your shoes can help reduce pressure on your muscles and alleviate pain.

4. Rest and Recovery: Ensuring you take regular breaks and allow time for muscle recovery between activities can be crucial in managing CCS symptoms.

Surgical Treatment (Fasciotomy)

If non-surgical methods do not provide sufficient relief, surgery may be necessary. The most common surgical option is a fasciotomy, which involves making small incisions in the fascia to relieve pressure. By cutting the fascia, the surgeon creates more space for the muscle to expand, thus reducing pressure and improving blood flow.

Fasciotomy is usually very effective, with many patients experiencing significant improvements in pain and functionality. However, as with any surgery, there are potential risks, so it’s essential to weigh the pros and cons with your healthcare provider.

Chronic compartment syndrome is a treatable condition that affects many athletes and active individuals. Recognising the symptoms early and exploring both non-surgical and surgical options can help you return to your activities pain-free. At MSK Doctors, we offer expert care and personalised treatment plans to help you manage chronic compartment syndrome effectively. If you suspect you might have this condition, contact us today for a consultation and find out how we can help you get back to your active lifestyle.

FAQ Section:

1. What is the main difference between acute and chronic compartment syndrome? Acute compartment syndrome is a medical emergency that requires immediate attention, often after a traumatic injury. Chronic compartment syndrome develops gradually with exercise and is not life-threatening but can cause persistent discomfort.

2. How is chronic compartment syndrome diagnosed? Your doctor may perform a physical exam and order tests to measure the pressure inside your muscle compartments. These measurements are usually taken before, during, and after exercise.

3. Can chronic compartment syndrome heal on its own? Chronic compartment syndrome doesn’t typically go away without treatment. Modifying your activities, doing physical therapy, or considering surgery are often necessary to relieve symptoms.

4. What happens during a fasciotomy? During a fasciotomy, a surgeon makes small incisions in the fascia around the affected muscle compartment to relieve pressure. This allows more room for your muscles to expand and reduces pain.

5. Can I continue exercising with chronic compartment syndrome? It depends on the severity of your symptoms. In some cases, switching to lower-impact exercises can help manage the condition. Always consult your healthcare provider before continuing exercise.

6. Is surgery always necessary for chronic compartment syndrome? No, surgery is typically a last resort after non-surgical treatments, such as physical therapy or activity modification, have been tried. Many patients manage the condition successfully without surgery.