Compartment syndrome
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| ICD-10 | T79.6 | |
|---|---|---|
| ICD-9 | 729.9, 958.8 | |
| DiseasesDB | 3028 | |
| MedlinePlus | 001224 | |
| eMedicine | emerg/739 pmr/33 sports/26 | |
| MeSH | C05.651.180 | |
Compartment syndrome is characterized by increased pressure within one or more fascial compartments so that vascular perfusion is compromised. Without prompt treatment, the resulting tissue hypoxia can lead first to nerve damage and eventually muscle death.
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[edit] Causes
Because the connective tissue that defines the compartment does not stretch, a small amount of bleeding into the compartment, or swelling of the muscles within the compartment can cause the pressure to rise greatly. Common causes of compartment syndrome include tibial or forearm fractures, ischemic-reperfusion following injury, haemorrhage, vascular puncture, intravenous drug injection, casts, prolonged limb compression, crush injuries, and burns.
When compartment syndrome is caused by repetitive heavy use of the muscles, as in a runner, it is known as chronic compartment syndrome (CCS). This is usually not an emergency, but the loss of circulation can cause temporary or permanent damage to nearby nerves and muscle.
[edit] Pathophysiology
Any condition that results in an increase in compartment contents or reduction in a compartment’s volume could lead to the development of an acute compartment syndrome. When pressure is elevated capillary blood flow is compromised. Edema of the soft tissue within the compartment further raises the intra-compartment pressure, which compromised venous and lymphatic drainage of the injured area. Pressure if further increased in a reinforcing vicious cycle until arteriole perfusion in compromised leading to further tissue ischemia.
Tissue pressure is normally below 10 mm Hg and is usually approximately zero. Blood flow through capillaries is at risk at pressures above 20 mm Hg and nerves and muscles may undergo necrosis at pressures greater than 30 – 40 mm Hg. Arteries and arterioles are stable at these pressures, however the tissues within the compartment dependent on the capillaries for nutrients suffer hypoxia.
Untreated compartment syndrome mediated ischemia of the muscles and nerves lead to eventual irreversible damage and death of the tissues within the compartment.
[edit] Symptoms and Signs
Pain is often reported early and almost universally. The description is usually of deep, constant, and poorly localized and is sometimes described as out of proportion with the injury. The pain is aggravated by stretching the muscle group within the compartment. Paresthesia (loss of sensation) in the cutaneous nerves of the affected compartment is another typical sign. A lack of pulse in areas distal to the compartment as well as paralysis of the limb are usually late findings. The compartment may feel very tense as well.
[edit] Diagnosis
CCS can be tested for using by gauging the pressure within the muscle compartments. If the pressure is sufficiently high, a fasciotomy may be required.
[edit] Treatment
Compartment syndrome is a medical emergency requiring immediate treatment by fasciotomy to allow the pressure to return to normal.
[edit] Complications
Failure to relieve the pressure can result in necrosis of tissue in that compartment, since capillary perfusion will fall leading to increasing hypoxia of those tissues. If left untreated, acute compartment syndrome can lead to more severe conditions including rhabdomyolysis and kidney failure.
