Alternative Names Volkmann's ischemic contracture, Volkmann's ischemic necrosis
Definition When pressure increases within a muscle compartment, the blood supply to the muscle is cut off and the muscle may die.
What is going on in the body? A group of muscles is contained within a compartment surrounded by a tough fibrous membrane. Small blood vessels supply the muscle with oxygen and other nutrients necessary to keep the tissue alive. If the pressure within the compartment is greater than the pressure of venous blood outflow, it prevents fresh, oxygenated blood from flowing in. The affected muscles then become deprived of blood. If this continues for more than 6 hours, the muscles die.
An acute form of compartment syndrome can occur rapidly after an injury, such as after a fracture of the lower leg bone or a crush injury if someone is buried under debris. Intermittent compartment syndrome is associated with a repetitive activity that causes increased pressure on the muscles. Running can sometimes cause intermittent problems.
What are the signs and symptoms of the condition? In an acute case, the person will usually complain of an injury, such as a lower leg fracture, followed by increasingly severe, constant pain in the affected muscles. Often the degree of pain seems greater than the severity of the injury.
Signs include:
swelling and tenderness of the muscle
numbness in the skin
difficulty making the muscle move
intense pain with stretching of the muscle
decreased pulses below the affected area
pale skin
The muscles most frequently involved are on the front of the lower leg or the palm side of the forearm.
With intermittent compartment syndrome, a runner may complain of tightness and aching in the calf muscles in the front or back of the lower leg. This occurs especially after running a relatively short distance and the person has to stop running. The tightness gradually goes away after the person stops running.
What are the causes and risks of the condition? Any activity or injury that increases the pressure significantly within the muscle compartment can cause compartment syndrome. Some common causes include:
bleeding after a fracture
swelling within the muscle compartment in reaction to the return of blood flow after a period of being deprived of blood
low blood pressure following loss of blood from the body. This low pressure contributes to muscle death because the muscle is further deprived of oxygen.
What can be done to prevent the condition? Acute compartment syndrome can sometimes be avoided by early stabilisation of a fracture. This may involve splinting, elevating the injured limb on a pillow, and applying ice to reduce swelling.
How is the condition diagnosed? In the acute case, diagnosis can usually be made based on the history of the injury, complaints of severe pain, and the characteristic signs. In addition, the raised pressure within the compartment can be measured with specialised instruments.
What are the long-term effects of the condition? If compartment syndrome is untreated, death of the muscles can occur. Muscles can become inactive and excessively tight. Toes or fingers may become fixed in a curled position with permanent numbness.
What are the risks to others? There are no risks to others.
What are the treatments for the condition? Diagnosis must be made accurately and promptly to assure a good outcome. Initial treatment consists of elevating the limb above the level of the heart. If a cast has been applied, it is removed. A surgical procedure known as a fasciotomy may be used to open the membrane leading to the affected muscles. The result is relief of pressure, allowing blood flow to return. Often the skin needs to be left open for a few days. It can be closed with sutures or a skin graft after the swelling goes down.
What are the side effects of the treatments? The muscles or fracture may become infected after surgery. The muscle and nerves may not return to normal after recovery.
What happens after treatment for the condition? A scar may appear where the skin was left open following surgery.
How is the condition monitored? The person will be taught to watch for symptoms and signs of worsening compartment syndrome. The doctor should be consulted if there are any other concerns.
Author: Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
