Olympic skier Lindsey Vonn revealed she had compartment syndrome. Here’s what that means

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Alpine skier Lindsey Vonn has been praised not only for her skills in her sport, but also for her ability to endure. Committing to compete despite tearing her anterior cruciate ligament just over a week before her event at 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 she had developed compartment syndrome, a rare but serious condition that can threaten a person’s life and limb.

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We asked experts to explain what compartment syndrome is and why it’s so dangerous.

What is compartment syndrome?

Every muscle and organ in the body is wrapped in a tough layer of tissue called fascia. Jason Lee, chief of vascular surgery at Stanford University School of Medicine, likens it to a thin envelope or sleeve.

Fascia holds your muscles in place when you run, for example, and prevents your organs from jostling when you cough or sneeze. But the robustness of this fabric can have drawbacks.

After a person experiences significant trauma to the body, such as a high-speed skiing accident that fractures their leg, the surrounding muscles can quickly bleed and swell. As the swelling increases, the pressure in the area between the muscle and the fascia increases. But because fascia is so strong, it can withstand this pressure. This can become a problem: if the pressure increases too much, it hinders blood flow to the area. Eventually, blood stops circulating completely, which can lead to tissue death and nerve damage: this is compartment syndrome.

“This is where it becomes a limb-threatening disease,” says Matthew Apicella, a physician at NYU Langone Health who is dual board-certified in emergency medicine and sports medicine.

“When you start to experience tissue damage or tissue necrosis, which is when that tissue starts to die, the literature indicates that this can happen as little as four to eight hours after the onset of compartment syndrome,” he says.

What are the symptoms of compartment syndrome?

Not everyone with an injury like Vonn’s will suffer from compartment syndrome. Apicella says current research suggests it occurs in 1 to 10 percent of all fractures, and is most common in the long bones of the body. And, says Lee, “the more severe the injury, the higher the risk of developing compartment syndrome.”

He and Apicella say one of the main ways doctors detect compartment syndrome is when a person begins to experience extreme, unexpected pain. “In medical training, we are taught to look for the 5 Ps,” says Apicella. The first P represents pain disproportionate to the examination. The other Ps are pallor, paresthesias, which is tingling or numbness in the area, paralysis and lack of pulse in the affected limb.

When someone has compartment syndrome, the first P can be telling: “When you press [the injury site]It doesn’t hurt very much because there’s often numbness, but they sit there in excruciating discomfort,” Lee says.

How to treat compartment syndrome

Compartment syndrome is marked by a build-up of pressure, so the only real treatment for this condition is to relieve this pressure. “If you just let something swell and swell and swell, the skin will literally break,” says Lee.

To prevent this and restore blood flow, doctors perform something called a fasciotomy, which is essentially a controlled injury to the skin. Long, deep incisions are made on either side of the injury, allowing swollen muscles to move and relieving the buildup of pressure.

“A fasciotomy can be a life- and limb-saving procedure. If you decide not to make the cut and allow it to expand, the nerve can die, leading to permanent muscle damage that will never allow a person to walk again or, in the worst case, the need for amputation,” says Lee. But it also means a longer and more complicated recovery, he says, because you have to heal the incisions as well as the initial injury.

And while he can’t comment directly on Vonn’s case, Lee says that sometimes the disease can actually be triggered by the surgeries needed to repair the original injury.

Immediately after a surgery like Vonn’s, in which doctors realign the bone, a phenomenon called reperfusion occurs, Lee says. During reperfusion, surrounding tissues that had been deprived of blood flow and oxygen suddenly regain blood flow. This rapid return can actually make the swelling worse and make 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’s important to know that if you have a fracture and the pain starts to get worse, it’s time to see a doctor to be evaluated by someone who will rule out these signs of compartment syndrome,” says Apicella.