The rise of non-traumatic extremity compartment syndrome in light of the opioid epidemic

Compartment syndrome of the extremity occurs when pressure within muscle fascia exceed the ability to perfuse the muscle. The elevated pressure compromises the circulation, ultimately resulting in tissue necrosis. It most often occurs in the lower leg or forearm, but can also occur in the upper arm, hand, thigh, abdomen, buttock or foot. Compartment syndrome has many causes but can largely be divided into two categories: traumatic and non-traumatic. Traumatic compartment syndrome is seen after direct trauma to the tissue, such as after a motor vehicle accident or crush injury. Non-traumatic compartment syndrome includes all the other etiologies such as: ischemia/reperfusion, burns, thrombosis, vascular disease, poor positioning during surgical procedures, and prolonged pressure due to altered consciousness. Compartment syndrome constitutes a medical emergency that requires prompt diagnosis and management as it can have dire consequences such as neurological deficit, muscle necrosis, amputation, or even death. The non-traumatic compartment syndrome cohort significantly differed from its traumatic counterpart with a higher proportion of women and older patients. These patients were more likely to have longer lengths of stay and die during admission. The overall incidence of non-traumatic compartment syndrome showed a significant rise over the study period and may be associated with the opioid epidemic. The North Eastern region of the US saw the greatest increase in both encounters for opioid abuse and non-traumatic compartment syndrome. We recommend that any patient with a prolonged period of unconsciousness and signs of limb ischemia (e.g. skin creases/markings from external compression, mottled appearance, asymmetrical vascular exam) be considered for extremity compartment syndrome given the high morbidity of delayed diagnosis and management.