Dear Doctors: What is compartment syndrome, and how does it happen? I developed this following an embolism from hip replacement surgery. I had eight days on wound vacuum-assisted closure, plus physical therapy. The hip is fine now, but nerve damage along my leg to my foot and ankle persists.
Dear Reader: To understand compartment syndrome, we need to begin with a bit of anatomy. In this context, the word "compartment" refers to specific groupings of muscles, along with the nerves and blood vessels that serve them. Because muscles are wrapped in a taut and tough membrane known as the fascia, these groupings form distinct units that are referred to as compartments.
When someone develops compartment syndrome, it means that something has caused an abnormal buildup of pressure within the affected muscles. The cause can be a wound, broken bone, deep muscle bruise, severe sprain or a cast or bandage that is too tight. The increase in internal pressure adversely affects the flow of blood throughout the tissues, which starves the muscles and nerves of nutrients and oxygen. Compartment syndrome can occur in any limb, but it is most commonly seen in the lower leg.
Depending on the cause, symptoms can range from mild to severe. These include cramps, pain or burning in the affected muscles and stiffness, numbness or tingling in the affected limb. If the muscle becomes herniated, swelling or a bulge may become visible.
Compartment syndrome can occur as a result of intensive exercise. This is known as chronic or exertional compartment syndrome, and the symptoms will typically subside with rest. When the condition arises due to injury, it is known as acute compartment syndrome. This is always a medical emergency.
In your case, an embolism led to compartment syndrome in the lower leg. An embolism is an arterial blockage caused by a foreign body, such as a blood clot or air bubble. While this is a known complication of hip replacement surgery, it is rare for an embolism to lead to compartment syndrome.
The most effective treatment of acute compartment syndrome is a surgical procedure known as fasciotomy. This involves cutting into the tough, inflexible fascia that surrounds the muscle, which allows the internal pressure to decrease. The vacuum-assisted closure of the wound, or VAC, that you underwent is a type of therapy used to aid in wound healing. As the name suggests, it works by lowering the air pressure in the region of the wound. Once the internal pressure of the muscles involved in compartment syndrome has been successfully eased, the focus shifts to healing the surgical site.
Prompt diagnosis followed by immediate treatment is crucial to recovery from acute compartment syndrome. Left unaddressed, it can lead to nerve damage, muscle damage, impaired blood flow and neuropathy. The cause of the initial injury that led to the condition also plays a role in the scope of the subsequent recovery. A neurologist can help you learn if there is lasting nerve damage in your leg and if ongoing physical therapy may be helpful.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
