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    Compartment Syndrome

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    Haziq Mars
    Compartment syndrome is a condition characterized by increased pressure within a closed muscle compartment, which can cause damage to muscle and nerve tissue. Acute compartment syndrome occurs due to trauma or injury that increases pressure, while chronic exertional compartment syndrome develops over time in athletes. The main symptoms are pain disproportionate to the injury that worsens with stretching or elevation of the limb, as well as paresthesia, pallor, paralysis, and loss of pulse in advanced cases. Treatment involves measuring compartment pressures, surgical fasciotomy to release pressure if elevated, and managing any underlying injuries. Prognosis is best when fasciotomy is performed promptly before muscle necrosis occurs.

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    Compartment Syndrome

    Uploaded by

    Haziq Mars
    371 views36 pages
    Compartment syndrome is a condition characterized by increased pressure within a closed muscle compartment, which can cause damage to muscle and nerve tissue. Acute compartment syndrome occurs due to trauma or injury that increases pressure, while chronic exertional compartment syndrome develops over time in athletes. The main symptoms are pain disproportionate to the injury that worsens with stretching or elevation of the limb, as well as paresthesia, pallor, paralysis, and loss of pulse in advanced cases. Treatment involves measuring compartment pressures, surgical fasciotomy to release pressure if elevated, and managing any underlying injuries. Prognosis is best when fasciotomy is performed promptly before muscle necrosis occurs.

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    Compartment syndrome is a condition characterized by increased pressure within a closed muscle compartment, which can cause damage to muscle and nerve tissue. Acute compartment syndrome occurs due to trauma or injury that increases pressure, while chronic exertional compartment syndrome develops over time in athletes. The main symptoms are pain disproportionate to the injury that worsens with stretching or elevation of the limb, as well as paresthesia, pallor, paralysis, and loss of pulse in advanced cases. Treatment involves measuring compartment pressures, surgical fasciotomy to release pressure if elevated, and managing any underlying injuries. Prognosis is best when fasciotomy is performed promptly before muscle necrosis occurs.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    371 views36 pages

    Compartment Syndrome

    Uploaded by

    Haziq Mars
    Compartment syndrome is a condition characterized by increased pressure within a closed muscle compartment, which can cause damage to muscle and nerve tissue. Acute compartment syndrome occurs due to trauma or injury that increases pressure, while chronic exertional compartment syndrome develops over time in athletes. The main symptoms are pain disproportionate to the injury that worsens with stretching or elevation of the limb, as well as paresthesia, pallor, paralysis, and loss of pulse in advanced cases. Treatment involves measuring compartment pressures, surgical fasciotomy to release pressure if elevated, and managing any underlying injuries. Prognosis is best when fasciotomy is performed promptly before muscle necrosis occurs.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    At a glance
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    The key takeaways are that compartment syndrome is a condition characterized by increased pressure within a closed muscle compartment that can cause tissue damage. There are two main types - acute and chronic exertional compartment syndrome.

    The main causes of compartment syndrome are conditions that reduce the volume of a compartment like casts/splints or increase the content like fractures, hemorrhage, burns or reperfusion after ischemia.

    The main signs and symptoms of compartment syndrome are pain that is disproportionate to the injury, pain with passive stretching of the affected area, tense swelling, numbness, weakness and pale/dusky skin over the compartment.

    Jasreena Kaur Sandal

    COMPARTMENT
    SYNDROME

    Definition
    condition

    characterised by raised
    pressure within a closed space with a
    potential to cause irreversible damage
    to the contents of the closed
    compartment
    Acute compartment syndrome
    Chronic exertional compartment
    syndrome

    Acute Compartment Syndrome


    pressure within an osseofascial
    compartment rises to a level that
    decreases the perfusion gradient
    across tissue capillary beds, leading
    to cellular anoxia, muscle ischemia,
    and death.

    Chronic Exertional Compartment


    Syndrome
    is an exercise-induced
    neuromuscular condition that causes
    pain, swelling and sometimes even
    disability in affected muscles of the
    legs or arms
    can occur in both beginning and
    seasoned athletes in sports that
    involve repetitive movement

    Where does it occur?


    Lower Extremity

    Gluteal
    Thigh
    Lower Leg
    Foot

    Upper Extremity

    Deltoid
    Arm
    Forearm
    Hand

    Muscle

    compartments of the
    forearm.
    The forearm consists of three major
    compartments: the volar, dorsal, and
    mobile wads.

    Compartments

    of the leg

    Etiology
    Conditions

    that
    1. Reduces the volume of a
    compartment
    2. Increases the content of the
    compartment

    Reduce the Volume


    Cast or Splint
    Circumferential constricting dressing
    Closure of fascia
    Military antishock trousers (MAST)
    3rd degree Burns (circumferential)
    Malfunctioning sequential
    compression devices (SCDs)
    Tight ski boots

    Increase the Content

    Fractures, direct tissue trauma

    Hemorrhage: vascular injury, coagulopathy, anti-coagulation

    Increased capillary permeability after burns

    Infusion or injection (infiltrated line)

    Reperfusion after period of ischemia

    Gunshot wound to thigh

    Drug/alcohol abuse and coma

    Compartment fluid injection

    Crush injuries

    Gastronomies or peroneus muscle tear

    Androgen abuse/muscle hypertrophy

    Ruptured Baker cyst

    High risk Injuries causing


    compartment syndrome
    Fractures of elbow (supracondylar
    fractures)
    Fractures of forearm bones
    Fractures of proximal third of tibia
    Multiple fractures of the foot and
    hand
    Crush injuries
    Burns

    Pathophysiology

    Pathophysiology
    Compartment Pressures Rise

    Venous obstruction occurs, causing further pressure


    escalation

    Low intramuscular arteriolar pressure is exceeded

    MUSCLE AND NERVE ISCHEMIA

    14

    Decreased tissue perfusion


    tissue death
    Muscle

    reversible damage after 4 hours; irreversible after

    8 hours
    Nerve damage irreversible after 8 hours
    Episodes

    of hypotension will therefore increase the extent


    of irreversible muscle damage
    In tissue damaged by injury, resistance to ischemia is
    decreased. A pressure of 20mm Hg below diastolic shown to
    cause ischemia
    15

    Ischaemic fibrotic contracture


    Areas of muscle infarction

    Hypovolumia +
    myoglobulinaemia
    Hyperkalamia

    Rabdomyolysis
    Hypovolumia
    Hyperkalamia
    Increase uric acid
    Metabolic acidosis

    Acute renal
    failure

    Cardiac arrest

    16

    Clinical Manisfestations
    6 Ps of compartment syndrome
    Parasthesi
    a

    Pulselessn
    ess

    Pain

    Paralysis

    Pressure

    Pallor

    1.Paresthesia
    Subtle first symptom Compartment
    Syndrome
    Best elicited by direct stimulation
    Complaints of tingling or burning
    sensations
    Loss of 2 point discrimination
    Can lead to numbness

    2. Pain
    Out of proportion to the injury
    Elicited by passive stretching of the involved
    compartment
    Described as throbbing or deep localized or diffuse
    Increases with the elevation of the extremity
    Unrelieved by narcotics
    May not be present if central or peripheral sensory
    deficits are also present
    Pain will diminish after pressure-induced ischemia
    affects the conductivity of the nerves in the
    compartment.

    3. Pressure
    Involved compartment or limb will feel tense and warm on
    palpation
    Skin is tight and shiny
    Skin may appear cellulitic
    Direct compartment pressure of 30-40 mmHg as measured
    by a wick, continuous infusion, or injection method such as
    the Stryker monitor normal intracompartmental tissue
    pressure is
    0-10 mmHg.

    Differential pressure of greater than 30 mmHg diastolic


    blood pressure minus compartment pressure as long as
    diastolic pressure remains high enough or at least 30 mmHg,
    the compartment will be perfuse

    4. Pallor
    Late sign
    Pale, grayish or whitish tone to skin
    Prolonged capillary refill (>3
    seconds)
    Cool feel to skin upon palpation due
    to lack of capillary perfusion

    5. Paralysis
    Late sign
    May start as weakness in active
    movement of involved or distal joints
    Leads to inability to move joint or
    digits actively
    No response to direct neural
    stimulation due to damage

    6. Pulselessness
    Late sign
    Very weak or lack of palpable or
    Doppler audible pulse
    Due to lack of arterial perfusion

    Other warning signs :


    Fractured blisters: represent areas of necrosis of the
    epidermis and separation of the skin layers-body
    attempts to relieve the pressure in the
    compartment.
    elevated

    temperature due to ischemia/necrosis of


    tissue and possible infectious response.

    stretch

    pain or pain on passive extension or


    hyperextension of digits (toes or fingers, depending
    on the site)

    Investigation
    Tissue

    Pressure Measurement
    Lab Studies
    Hematology/chemistry laboratory studies Serum
    myoglobin and CK measurements should be obtained
    to determine the degree of muscle necrosis.

    Serial CK levels may show increases indicative of


    a developing CS.
    High CK levels should alert to possible
    rhabdomyolysis.

    Complete blood cell count (CBC) and coagulation studies


    elevated WBC (white blood cell count) and ESR
    (erythrocyte sedimentation rate) levels -severe
    inflammatory response
    elevated

    Serum Potassium due to cell damage

    lowered

    Serum pH levels due to acidosis

    anemia

    worsens muscle ischemia

    look

    for disseminated intravascular coagulation (DIC),


    which is rare.

    Imaging Studies

    Plain

    radiographs of the affected extremity are used to determine


    fracture pattern, soft-tissue injury, and radiographic clues that may
    indicate occult fractures.

    MRIs

    may show increased signal intensity in an entire compartment


    on T2-weighted, spin-echo sequences.

    Computed

    tomography (CT) scanning is especially useful if pelvic or


    thigh CS is in the differential diagnosis.

    Lower

    extremity venous Doppler or arterial ultrasonography (US) is


    performed as needed to address possible DVT or arterial occlusion.

    Management
    Medical Theraphy
    Place

    the affected limb(s) at the level of the heart.

    Elevation

    is contraindicated because it decreases arterial blood


    flow and narrows the arteriovenous pressure gradient and thus
    worsens the ischemia.

    Remove

    cast, bandages and any dressing.

    Correct

    hypo perfusion with crystalloid solution and blood

    products.
    Mannitol

    may reduce compartment pressures and lessen


    reperfusion injury

    Surgical Theraphy
    emergency fasciotomy
    -should be done in less than 6 hours and no
    later than 12 hours after onset
    -usually left open protected by suitable sterile
    dressings
    -Inspection of the wound after 48 hours may
    necessitate further necrotic tissue excision.
    -delayed skin closure or skin grafting may
    become treatment options
    subsequent orthopedic reductionor fracture
    stabilization and vascular repair

    Prognosis
    Depends upon the timeliness of diagnosis and treatment
    Dependent upon etiology and age of patient
    If recognized and treated before my necrosis, >90% recover
    function
    May have some loss of muscle power due to the fasciotomy

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