Downhill skier Lindsey Vonn has won praise not only for her ability at her sport but also for her ability to endure. Committed to competing at this year’s Winter Olympics despite tearing her anterior cruciate ligament just a week before her event, the decorated American skier crashed just seconds into her race, fracturing her left leg in multiple places. And In an Instagram post on MondayShe revealed that her injury was even more complex and life-threatening than we knew.
The Olympic skier revealed that she has been diagnosed with compartment syndrome, an uncommon but serious condition that can be life and limb threatening to a person.
We asked experts to explain what compartment syndrome is and why it’s so dangerous.
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What is compartment syndrome?
Every muscle and organ in the body is surrounded by a tough layer of tissue called fascia. jason leechief of vascular surgery at Stanford University School of Medicine, compares it to a thin envelope or sleeve.
For example, fascia holds your muscles in place when you’re running, and keeps your limbs from moving around when you cough or sneeze. But the strength of this tissue can also have negative aspects.
When someone experiences a significant trauma to their body—such as a high-speed ski accident that fractures their leg—the surrounding muscles can rapidly bleed and swell. As the swelling increases, pressure builds up in the area between the muscle and the fascia. But because the fascia is so strong, it can withstand that pressure. This can become a problem: If the pressure gets too high, it restricts blood flow to the area. Eventually, blood stops flowing completely, resulting in tissue death and nerve damage – this is compartment syndrome.
“This is where it becomes a limb-threatening condition,” says Matthew ApicellaA physician at NYU Langone Health who is dual certified in emergency and sports medicine.
“When you start to have tissue damage or tissue necrosis, which is when that tissue starts to die, the literature would say that can happen only four to eight hours after compartment syndrome begins,” he says.
What are the symptoms of compartment syndrome?
Not everyone with an injury like Vaughn’s will experience compartment syndrome. Apicella says current research shows it occurs in anywhere from 1 to 10 percent of all fractures, and it’s more common in the longer bones in the body. And, says Lee, “the more severe the injury, the greater the chance of developing compartment syndrome.”
Both he and Apicella say that a major way doctors detect compartment syndrome is when a person begins to experience extreme, unexpectedly high levels of pain. “In medical training, we are taught to look for the 5 ‘P’s,’” Apicella says. The first P represents pain that is out of proportion to the examination. Other P’s are pallor, paresthesia, meaning tingling or numbness in the area, paralysis and pulselessness in the affected limb.
When someone has compartment syndrome, the first P can be a gift: “When you press (the injured area), there’s not as much pain because there’s often numbness, but they’re sitting there in unbearable discomfort,” says Lee.
How to Treat Compartment Syndrome
Compartment syndrome is characterized by a buildup of pressure, so the only real treatment for this condition is to relieve that pressure. “If you let something swell, and swell, the skin will literally burst,” says Lee.
To stop this and get blood flowing again, doctors do what is called a fasciotomy, which is essentially a controlled tear of the skin. Long, deep incisions are made on either side of the injury, giving the swollen muscles some room to move and relieving pressure buildup.
“Fascotomy can be a life- and limb-saving procedure where, if you decide not to cut and let it dilate, the nerve can die, causing permanent muscle damage that doesn’t allow a person to walk again, or, in the worst case, requiring amputation,” says Lee. But it also means a longer and more complicated recovery, he says, because you have to heal from the incisions as well as the original injury.
And though he can’t comment directly on Vaughn’s case, Lee says that sometimes the condition may actually be triggered by the surgery required to repair the original injury.
Immediately after a surgery like Vaughn’s, in which doctors reattach the bone, a phenomenon called reperfusion occurs, Lee says. In reperfusion, surrounding tissue that had been deprived of blood flow and oxygen suddenly regains blood flow. This rapid withdrawal can actually make inflammation worse and make compartment syndrome more likely.
Both experts emphasize that for the everyday athlete, compartment syndrome is not common, but it is important to be aware of. Apicella says, “It’s important to know that if you have a fracture and your pain starts getting worse, it’s time to seek medical attention to get evaluated by someone who will rule out those signs of compartment syndrome.”
