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The fascia are one of the body's most important tissues, but most people have never even heard of them. They are bands of collagen that surround organs and muscles and keep them from having to move as if they were glued to bones and skin. There are superficial fascia that are the lowest layer of the skin. They help the skin hold together. There are visceral fascia around organs that keep them from prolapse, plopping into a floppy shape. And there are deep fascia that surround individual muscles or groups of muscles. Deep fascia focus the power of a muscle into directions that optimize easy motion.

A fascial compartment contains muscles and nerves that work together, surrounded by fascia. You have fascial compartments for your upper arms and thighs, and for your forearms and the muscles below the knee. There are six compartments in each of your wrists, and ten in each of your hands. There are fascia in your buttocks, feet, shoulders, and core muscles.

What can go wrong with the fascia?

The deep fascia around muscles or groups of muscles don't have their own blood supply. There can be lots of blood vessels that have a kind of blind end where they meet fascia, and blood has to travel through tiny, narrow vessels to reach the muscles and nerves inside. Blood also has to circulate through the same tiny vessels as it returns to the veins to carry waste products and carbon dioxide out of the compartment.

When a muscle or the bone underneath it or the tendon attaching it to the bone are injured, there is a secretion of histamine (the same chemical that causes allergies) to make sure that the injured tissue gets the blood and nutrients it needs to heal. The tissues also send out a chemical signal to the immune system to send out specialized white blood cells known as macrophages to clean up dead or injured tissue.

Macrophages are large cells. They can get "stuck" in small blood vessels. When blood and fluid can go into the compartment but can't come out, there is swelling. The fascia function by being stiff enough to transmit muscle motion. They don't have a lot of "give." They are also highly sensitive to pain. Swelling leads to ischemia (a failure of blood circulation), which leads to the secretion of more histamine, which leads to more swelling. Medical intervention may become necessary.

Fascial injuries are especially common after gunshot wounds, broken bones, crushing injuries, and stabbings. However, they can also occur in patients on blood thinners. The blood thinners (anticoagulants) make it easier for blood to flow in, but even a tiny injury can make it hard for blood to flow out. Something as simple as drawing blood for a blood test can result in compartment syndrome. Athletes and soldiers who do hard exercise can develop compartment syndrome even without an injury. Often a fasciotomy, opening the fascia, has to be performed first before treating the underlying injury to prevent not just intense pain but death of muscle tissue.

Only a doctor can do the emergency treatment. However, once you have had medical treatment, there are things you can do to minimize pain.

  • During healing, keep the injured compartment at the same level as your heart. You don't want it higher, because that limits circulation to the injured fascia. You don't want it lower, because that increases pressure in the injured fascia. You may have to spend as much time as possible "nose higher than toes" if you have an injury to your legs or arms and hands propped up on a high table if you have an injury to your arms or hands.
  • Limit the amount of protein in your diet. It takes just a few hours for a fascial injury to start producing enough damaged tissue that your kidneys have trouble processing the protein waste products. Even at home, chowing down on a big steak or going on a high-protein diet can stress your kidneys and add to swelling. 
  • Assuming you have normal kidney function, you need to make sure you stay adequately hydrated (drink the often-recommended 8 glasses of water a day) to maintain healthy circulation, unless your doctor tells you otherwise,
  • Your doctor may need to refer you to a hematologist (blood specialist) if you have problems with venous circulation. 
  • Sometimes the pain after compartment syndrome is "nerve pain," caused by injuries to the nerves not pressure in the compartment. In these cases, pain relievers won't work, and icing the painful area won't either, but medications more often used to treat depression or neurological issues will. Don't take more and more Aspirin and Ibuprofen if they aren't working for you. See you doctor about getting appropriate medications for pain. Phenytoin (Dilantin), gabapentin (Neurontin), or carbamazepine (Tegretol) may make you comfortable when pain relievers do not.

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