Understanding Compartment Syndrome: The Difference Between Acute and Chronic
When it comes to orthopedic emergencies and overuse injuries, compartment syndrome is one of the most misunderstood conditions. Whether it occurs suddenly after trauma or gradually from exercise, knowing the difference between acute and chronic compartment syndrome is key to recognizing symptoms early and getting the right treatment.
Below, Dr. John Paul Elton, foot and ankle doctor at Vail-Summit Orthopaedics & Neurosurgery (VSON), answers common questions about this condition, from what is compartment syndrome caused by to how to prevent compartment syndrome in active individuals.
What Is Compartment Syndrome?
Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space, called a “compartment”, in the leg, arm, or other areas. These compartments are surrounded by fascia, a tough tissue that doesn’t easily expand. When swelling or bleeding increases pressure within that compartment, blood flow is reduced, leading to pain and possible tissue damage.
Understanding how compartment syndrome occurs is critical: as pressure rises, oxygen can’t reach muscles and nerves. Without quick intervention, this can lead to permanent damage or loss of function.
What Is Compartment Syndrome Caused By?
Acute compartment syndrome is most often caused by a traumatic injury, such as a fracture, crush injury, or severe bruising. In some cases, it can occur after surgery or from tight casts or bandages that restrict circulation.
Meanwhile, chronic exertional compartment syndrome (CECS) is what compartment syndrome is caused by repetitive, high-impact activities such as running, skiing, or cycling. Over time, muscles swell with exercise, but the tight fascia prevents proper expansion, leading to increased pressure and pain during activity.
In both cases, what compartment syndrome is caused by relates to poor circulation and rising pressure that cuts off oxygen to muscle tissue.
How Compartment Syndrome Occurs
In acute cases, how compartment syndrome occurs is usually due to a rapid increase in swelling following trauma. This is a medical emergency and often requires immediate surgical treatment (fasciotomy) to relieve pressure and restore circulation.
In chronic cases, how compartment syndrome occurs is much slower. The pain develops gradually during exercise and subsides with rest. Athletes often describe burning, cramping, or tightness in their legs that resolves minutes after stopping the activity, but returns each time they resume.
Understanding how compartment syndrome occurs in these two scenarios helps determine whether urgent intervention or long-term management is needed.
What Are the Symptoms of Compartment Syndrome?
Deep, aching, or burning pain
Tightness or fullness in the affected muscle
Numbness or tingling
Weakness or difficulty moving the limb
In acute cases: pain that feels out of proportion to the injury
If symptoms persist or worsen despite rest, seek immediate evaluation from an orthopedic specialist. Acute compartment syndrome is not something to wait on, it’s an emergency.
How to Prevent Compartment Syndrome
Because how to prevent compartment syndrome depends on the type, strategies vary. For acute compartment syndrome, prevention focuses on early recognition and treatment of traumatic injuries. Avoid wrapping limbs too tightly, and report any increase in pain, numbness, or swelling after a cast or injury.
For chronic compartment syndrome, how to prevent compartment syndrome centers around activity modification and biomechanical correction. Gradual training increases, proper footwear, and physical therapy to improve muscle balance and flexibility can all help.
Athletes can also work with a specialist to assess how to prevent compartment syndrome by identifying overuse patterns and optimizing form during running, skiing, or biking.
How Is Compartment Syndrome Diagnosed and Treated?
Diagnosis often involves a physical exam, imaging, and in some cases, direct pressure testing within the muscle compartments.
Acute compartment syndrome typically requires emergency fasciotomy, a surgical procedure to release the fascia and relieve pressure.
Chronic compartment syndrome may be managed non-surgically through rest, physical therapy, or gait retraining, but in persistent cases, surgical release may still be needed.
When to See an Orthopaedic Specialist
If you suspect compartment syndrome, especially if pain is severe, persistent, or associated with swelling or numbness, contact an orthopaedic specialist immediately. Dr. John Paul Elton and the Vail-Summit Orthopaedics & Neurosurgery team specialize in diagnosing and treating both acute and chronic compartment syndromes, helping patients return safely to their active mountain lifestyles. Contact our team today!