What Are the 5 Ps of Compartment Syndrome?

Reviewed on 5/6/2021

Compartment syndrome is a very painful condition that occurs when the pressure in and around the muscles increases.
Compartment syndrome is a very painful condition that occurs when the pressure in and around the muscles increases.

Compartment syndrome is a very painful condition that occurs when the pressure in and around the muscles increases. A compartment is a group of muscles, nerves and blood vessels covered by a thin, firm membrane called a fascia. In compartment syndrome, the blood flow, oxygen and nutrients to the muscles and nerves are cut off. Compartment syndrome often occurs in the lower leg but can also affect other parts of the leg, feet, arms, hands, abdomen and buttocks. There are different types of compartment syndrome and they have different causes and management. This is a dangerous condition that can cause serious complications and possible death. It is important to recognize the signs and symptoms of compartment syndrome and seek emergency medical attention immediately or in less than 24 hours to prevent long-term complications.

The "5 Ps" often associated with compartment syndrome that help recognize the syndrome are

Pain

Other signs and symptoms of compartment syndrome include

  • Swelling of the muscle
  • Burning
  • A feeling of tightness in the muscle

What are the different types of compartment syndrome?

There are two kinds of compartment syndrome:

  • Acute compartment syndrome: This occurs suddenly and is typically caused by a bad injury, such as a crushing injury. It requires immediate medical attention. If not treated in time, it can permanently damage muscles, cause disability, paralysis or even death.
  • Chronic compartment syndrome: This usually occurs due to physical exertion, such as intense exercise and is typically not an emergency. It is also called an exertional compartment.

What causes compartment syndrome?

Different types of injuries that can cause acute compartment syndrome are

  • Severely bruised muscle
  • Major road traffic accident
  • Crush injury
  • Fracture
  • A sudden return of blood flow after circulation gets blocked, such as during surgery
  • Very tight casts or bandages that are worn for a while

Types of activities that can cause chronic compartment syndrome

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How is compartment syndrome treated?

Treatment of compartment syndrome depends on whether it is acute or chronic.

Treatment of acute compartment syndrome

This requires immediate medical treatment. A surgery called fasciotomy would be required. To relieve pressure, the surgeon makes an incision (cut) through the skin and the fascia, which is the cover of the compartment. After the swelling and pressure go away, the surgeon closes the incision. Sometimes, a skin graft (taking skin from another area of the body to cover the defect/incision) could be needed to close the incision.

Treatment of chronic compartment syndrome

This usually goes away with rest, medication, physical therapy, low impact exercises recommended by the doctor. Also, wearing shoe inserts and taking prescription anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), help. If noninvasive treatment options fail, a fasciotomy may be advised.

What happens if acute compartment syndrome goes untreated?

If acute compartment syndrome is not treated immediately, the following complications can occur:

  • Muscle rigidity
  • Muscle deformities
  • Permanent damage to muscles and nerves
  • Permanent disability
  • Amputation
  • Death

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References
Rasul AT Jr. Acute Compartment Syndrome. Medscape. https://emedicine.medscape.com/article/307668-overview

Tucker AK. Chronic Exertional Compartment Syndrome of the Leg. Curr Rev Musculoskelet Med. 2010;3(1-4):32-37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941579/

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