Chronic compartment syndrome: tips on recognizing and treating: the patient's history offers more important clues than physical exam

Journal of Family Practice,  Nov, 2005  by Jon Englund

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FAST TRACK Though the debate is unresolved, most clinicians agree that the symptoms of CCS are due to local ischemia

FIGURE 1

How chronic compartment syndrome develops

The lower leg comprises 4 main compartments: anterior, lateral, superficial posterior, and deep posterior. Some authorities think the superficial posterior compartment should be further divided into the lateral and medial superficial posterior compartments, reflecting the 2 heads of the gastrocnemius muscle. (1,2) While all compartments can be affected in CCS, the ones most commonly involved are the anterior (40% to 70%) and deep posterior compartments (15% to 30%). (1,2,3)

Though the debate over CCS pathophysiology is unresolved, most clinicians agree that symptoms are due to local ischemia. Exercise increases muscle volume by 20% secondary to increased blood volume and interstitial edema.' Some individuals are unable to accommodate this extra volume and exhibit a corresponding increase in intracompartmental pressure. Elevated compartment pressure impairs capillary blood flow, resulting in tissue ischemia and the characteristic symptoms of CCS.