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Downhill skier Lindsey Vonn has won plaudits not only for her ability in her sport but also for her capacity to endure. By committing to compete despite tearing her anterior cruciate ligament just more than a week before her event in this year’s Winter Olympics, the decorated American skier crashed just seconds into her race, fracturing her left leg in several places. And in an Instagram post on Monday, she revealed that her injury was even more complex and life-threatening than we knew.
The Olympic skier revealed that she developed compartment syndrome, an uncommon but serious condition that can be threatening to a person’s life and limb.
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We asked experts to explain what compartment syndrome is and why it is so dangerous.
What is compartment syndrome?
Every muscle and organ in the body is encased in a tough layer of tissue called fascia. Jason Lee, chief of vascular surgery at the Stanford University School of Medicine, compares it to a thin envelope or sleeve.
Fascia keeps your muscles in place when you are running, for example, and stops your organs from jostling around when you cough or sneeze. But this tissue’s sturdiness can have downsides.
After someone experiences a significant trauma to their body—such as a high-speed ski crash that fractures their leg—the surrounding muscles can rapidly bleed and swell. As the swelling increases, pressure in the area between the muscle and the fascia builds. But because the fascia is so strong, it can withstand that pressure. That can become a problem: if the pressure rises too much, it impedes blood flow to the area. Eventually, the blood stops flowing entirely, which can result in tissue death and nerve damage—that’s compartment syndrome.
“That’s where it ends up being a limb-threatening condition,” says Matthew Apicella, a physician at NYU Langone Health, who is double-certified in emergency and sports medicine.
“When you start to get tissue damage or tissue necrosis, which is when that tissue starts to die, the literature will say that that can happen just four to eight hours after compartment syndrome starts to happen,” he says.
What are the symptoms of compartment syndrome?
Not everyone with an injury like Vonn’s will experience compartment syndrome. Apicella says that current research suggests it occurs in anywhere from 1 to 10 percent of all fractures, and it is more common in the long bones in the body. And, Lee says, “the more severe the injury, the higher the likelihood of developing compartment syndrome.”
Both he and Apicella say that one of the key ways doctors spot compartment syndrome is when a person starts to experience extreme, unexpectedly high degrees of pain. “In medical training, we are taught to look for the 5 ‘P’s,’” says Apicella. The first P stands for pain that is out of proportion to the exam. The other P’s are pallor, paresthesia, which means tingling or numbness in the area, paralysis and pulselessness in the affected limb.
When someone has compartment syndrome, the first P can be a giveaway: “When you press on [the injury site], it doesn’t hurt that much because there’s often numbness, but they are sitting there in excruciating discomfort,” Lee says.
How to treat compartment syndrome
Compartment syndrome is marked by a buildup of pressure, so the only real treatment for the condition is to relieve that pressure. “If you just let something swell and swell and swell, the skin will literally break,” Lee says.
To prevent that and to get blood flowing again, doctors perform what’s called a fasciotomy, which is essentially a controlled break of the skin. Long, deep incisions are made on either side of the injury, allowing the swollen muscles some room to move and relieving the buildup of pressure.
“A fasciotomy can be a life- and limb-saving procedure where, if you decide not to make the cut and let it expand, the nerve can die, leading to permanent muscle damage that never allows a person to walk again, or, worst case scenario, the need for amputation,” Lee says. 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 while he can’t comment directly on Vonn’s case, Lee says that sometimes the condition can actually be triggered by the surgeries needed to fix the original injury.
Immediately after a surgery like Vonn’s, in which doctors realign the bone, a phenomenon called reperfusion happens, Lee says. In reperfusion, the surrounding tissues that had been starved of blood flow and oxygen suddenly get blood flow back. This rapid return can actually make swelling even worse and compartment syndrome more likely.
Both experts emphasize that for the everyday athlete, compartment syndrome is not common, but it is something to be aware of. “It is important to know that if you have a fracture and you start to get worsening pain, then it’s time to seek medical attention to get evaluated by someone who is going to rule out those signs for compartment syndrome,” Apicella says.