Severe Leg Pain Symptom. Compartment Syndrome and Other Possible Causes.

Compartment syndrome.  What is it and what do I do about it?If you’re a regular exerciser, a weight lifter or athlete, or have had an injury, pain is to be expected at some time.  But what if it’s severe, gets worse, or just won’t go away?

There are several causes of severe limb pain.  We’re going to look mainly at Compartment Syndrome, but also Shin Splints and Blood Clots.  There are links to more detail on these last 2 in the article.Having severe pain in your arms, or more commonly legs after heavy exercise or trauma, can indicate Compartment Syndrome.  It can occur in the abdomen or buttocks as well but this is less common.

Other symptoms are:

  • Severe pain that doesn’t go after taking pain medication and/or elevating the limb
  • Pain that gets worse rather than better
  • Pain that is worse when the limb is pressed or squeezed
  • Severe pain on moving the limb or the foot/hand
  • Loss of sensation in the arm/let
  • Paleness of the skin in the affected area
  • Weakness of the limb.

Symptoms appear within about 48 hours of the injury.

Compartment Syndrome is most common in the lower legs but can occur in the arms, feet, ands, upper leg or abdomen.

If you have these symptoms (or even 1 or 2 of them) you should seek medical help without

delay.   Compartment Syndrome is a serious condition and can lead to tissue and nerve damage.  In severe cases the limb may need to be amputated.

When treated quickly the outlook is good.

 What are the tests for Compartment Syndrome?

Tests for compartment syndrome are carried out by a medical professional.  Seeing a doctor at the Emergency Room makes the most sense as a general practitioner may not be able to make the right diagnosis.

The doctor will do a specialist test that involves measuring the pressure inside the leg.  This is done by putting a needle, which is attached to a pressure reader into the affected area.

You may also need an MRI scan.

 What is the treatment for Compartment Syndrome?

If tests confirm that Compartment Syndrome is the cause of your severe leg or arm pain, you will need surgery.  The operation is called a fasciotomy (say ‘fash-y-otto-me’).

Surgery opens the limb to relieve the pressure.  Any dead muscle tissue will be removed at the same time.  The wound is left open; it may be closed when the pressure has gone down or skin grafts may be needed.

If there has been trauma to the limb and it’s in a cast which has caused the problem, then this will be removed to relieve the pressure and the situation monitored in case surgery is needed.

If treatment isn’t carried out soon enough, the limb may need to be amputated as the tissue and nerves become damaged and will die.

What causes Compartment Syndrome?

You can see from the diagram that in the body, muscles are separated by 2 layers of non-stretchy tissue called fascia (say ‘fash-ee-ah’).  This fascia is a compartment that contains nerves and blood vessels.

If the pressure in the fascia rises for some reason then this affects those nerves and blood vessels and stops them working.  This gives the symptoms of numbness, pins and needles and the pain, and causes the muscle tissues to die.

Compartment syndrome - diagram with labels

Compartment syndrome diagram.
Fascias wrap around the compartments.

Compartment Syndrome can be caused by:

  • Vigorous exercise
  • Crush injury
  • Bleeding from an injured blood vessel in the limb
  • Snake bites
  • Plaster casts that are too tight
  • An intravenous drip/drugs that leak around the vein
  • Broken bones (fractures)
  • Soft tissue injuries.

Chronic compartment syndrome can occur after repeated activity such as running.  The pain typically increases during the activity.

Shin Splints as a cause of leg pain.

Compartment Syndrome and Shin Splints are sometimes confused.

With Shin Splints the pain is mainly down the front of the shin (lower leg) bone.  You can see this from the diagram.

  • The pain usually gets better with rest and it doesn’t hurt to move the feet.
  • There isn’t usually any swelling in the leg.
  • Shin Splints are often caused by running/vigorous exercise but not but other trauma to the legs.
  • The pain is usually in both legs.

See this article for more on Shin Splints.

Blood clots – DVT – as a cause of leg pain.

Like Compartment Syndrome, blood clots in the legs or abdomen are a serious medical problem.

They can happen after an operation or trauma to the leg but not because of exercise.

The symptoms of a DVT (deep vein thrombosis), which is a clot in the leg, include

  • Swelling of one leg (not usually both)
  • The leg may look red/purple/mottled
  • Pain that may get a little better if the leg is raised
  • The leg is tender to the touch
  • The leg is hot to the touch.

There are several risk factors (see very bottom of this webpage for more about risk factors) that include being over 40 years old, being over weight, having varicose veins and having other illnesses such as cancer.

See this article on thrombosis for more information.

Further information from www.patient.co.uk and http://www.nlm.nih.gov/medlineplus

Elspeth Raisbeck

Author ER

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