Transcript Compartment Syndrome

COMPARTMENT
SYNDROME
INTRODUCTION
Compartment syndrome (CS) is a limbthreatening and life-threatening condition
Compartment syndrome is a condition that
occurs when injury causes generalized
painful swelling and increased pressure
within a compartment to the point that
blood cannot supply the muscles and
nerves with oxygen and nutrients.
INTRODUCTION
Compartment syndrome has been found
wherever a compartment is present: hand,
forearm, upper arm, abdomen, buttock,
and entire lower extremity. Almost any
injury can cause this syndrome, including
injury resulting from vigorous exercise.
COMPARTMENT SPACE
Thick layers of tissue, called fascia, separate groups of
muscles in the arms and legs from each other. Inside each
layer of fascia is a confined space, called a compartment. The
compartment includes the muscle tissue, nerves, and blood
vessels. Fascia surrounds these structures, similar to the way in
which insulation covers wires.
Fascia do not expand. Any swelling in a compartment will lead
to increased pressure in that area, which will press on the
muscles, blood vessels, and nerves. If this pressure is high
enough, blood flow to the compartment will be blocked. This
can lead to permanent injury to the muscle and nerves. If the
pressure lasts long enough, the muscles may die and the limb
may need to be amputated.
TYPES OF COMPARTMENT
SYNDROME
There are two types of compartment
syndromes, acute and chronic. Acute
compartment syndrome is usually caused
by trauma. Chronic compartment
syndrome is also known as exercise
induced compartment syndrome
ACUTE COMPARTMENT
SYNDROME
Acute compartment syndrome is usually caused
by trauma. Examples of trauma include crush
injury, muscle tear, burn injury, bite injury (dog,
insect, snake) or car accident. Acute
compartment syndrome can also be caused by a
cast that is too tight, drug overdose or
electrocution.
CHRONIC COMPARTMENT
SYNDROME
Chronic compartment syndrome is also known
as exercise induced compartment syndrome or
exertional compartment syndrome. It is most
often seen in the lower legs and is more
common than acute compartment syndrome.
When exercising, blood flow to the muscles
increases and the muscles expand within the
compartments. The expansion increases the
pressure in the compartments and the fascia
does not allow enough room for the expansion,
which leads to the pain.
CAUSES
Because of injury, pressure can increase within the
compartment to swelling (fluid accumulation) or bleeding.
In non-contracting muscle, the compartment pressure is
normally about 0-15 mmHg of pressure. If the pressure
within the compartment increases, most individuals
develop compartment syndrome. When these high
compartment pressures are present, blood cannot
circulate to the muscles and nerves to supply them with
oxygen and nutrients. Compartment syndrome
symptoms such as pain and swelling will occur.
CAUSES
As the muscle cells lose their blood and oxygen
supply, they use anaerobic metabolism and
begin to die. If the condition is not recognized
and treated, the whole muscle can die, scar
down, and contract. Similarly, nerve cells that
are damaged may fail causing numbness and
weakness in the structures beyond the injury
site. If infection or necrosis develops, the
individual may need the limb amputated to
prevent death.
SIGN AND SYMPTOM
"5 Ps" (pain, paresthesia [change in
sensation], pallor [pale coloration],
paralysis, and poikilothermia [inability to
control temperature], pulselessness.
ACUTE COMPARTMENT
SYNDROME
•Decreased or abnormal sensations (numbness,
tingling) in the area
Severe swelling (edema)
Excruciating pain
Pain gets worse with stretching the affected
muscles
Muscle weakness
Paleness (pallor)
Absent pulses (no blood flow)
CHRONIC COMPARTMENT
SYNDROME
Pain starts as dull ache
Pain occurs within 30 minutes of starting
to exercise
Burning, cramping, aching, tightness
develop if continue exercising
Pain goes away after stopping exercise
DIAGNOSIS OF ACUTE
COMPARTMENT SYNDROME
 Diagnosed based on the history (was there
trauma?) and physical exam findings (extreme
pain and swelling).
 Compartment pressure testing.
DIAGNOSIS OF CHRONIC
COMPARTMENT SYNDROME
x-rays : to make sure do not have a stress
fracture.
MRI
Compartment pressure testing
COMPARTMENT PRESSURE TESTING
Compartment pressure testing is done twice,
once before exercise and once after exercise. It
is best to try and perform the exercise that
brings on the pain.
The test involves numbing the area to be tested
with a needle and local anesthesia. Once feel
numb, a pressure gauge device with a needle is
inserted into the chosen compartment and a
pressure amount is measured.
COMPARTMENT PRESSURE TESTING
The test is considered positive if a pressure
greater than or equal to 15 mmHg before
exercise or greater than or equal to 30 mmHg
one minute after exercise or greater than or
equal to 20 mmHg five minutes after exercise.
If the pressure is greater than 30 mmHg, then
surgery is needed right away. It only takes about
four hours before the high pressure will start to
damage the muscles, nerves and blood vessels
in the compartments.
Clinical Diagnosis
(Taken pre/post exercise w/ slit catheter under local
anesthesia)
Measurement
Pressure
Pre-exercise
1 min Post-exercise
5 min Post-exercise
> 15 mm Hg
> 30 mm Hg
> 20 mm Hg
Pedowitz et al.
MANAGEMENT OF COMPARTMENT
SYNDROME
Time is of the essence in diagnosing and
treating compartment syndrome. Irreversible
nerve damage begins after 6 hours.
Rest, Ice, Elevation No Compression
NSAIDS
Stretching
Release tighten bandage
Fasciotomy of all involved compartments > 30
mmHg
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