Compartment syndrome
From Wikipedia, the free encyclopedia
| 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 is 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
The 5 "P's" -- Pallor, paresthesias, pulse deficit, paralysis, and pain on passive extension of the compartment-- are useful in recognition in the latter stages of compartment syndrome. 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.
If any of these occur, return to the Emergency Department immediately, or nearest Hospital.
[edit] Diagnosis
CCS can be tested for by gauging the pressure within the muscle compartments. If the pressure is sufficiently high, a fasciotomy may be required.
[edit] Treatment
Acute compartment syndrome is a medical emergency requiring immediate surgical treatment known as a fasciotomy to allow the pressure to return to normal.
Chronic compartment syndrome in the lower leg can treated conservatively or surgically. Conservative treatment includes rest, anti-inflammatories, and stretching. In cases where symptoms persist the condition should be treated by a surgical procedure, subcutaneous fasciotomy or open fasciectomy [1]. Without treatment chronic compartment syndrome can develop into the acute syndrome [2]. A possible complication of surgical intervention for chronic compartment syndrome can be chronic venous insufficiency.
[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.
[edit] See also
[edit] External links
- Duke Orthopedics compartment_syndrome
- Merck Home 05-062a
- Fasciotomy, Chronic Venous Insufficiency, and the Calf Muscle Pump
- Compartment syndrome
- Saphenous nerve injury after fasciotomy for compartment syndrome
[edit] Works Cited
- ^ Leversedge FJ, Casey PJ, Seiler 3rd JG, et al. Endoscopically assisted fasciotomy: description of technique and in vitro assessment of lower-leg compartment decompression. Am J Sports Med 2002;30(2):272-8.
- ^ Mubarak SJ, Owen CA, Garfin S, et al. Acute exertional superficial posterior compartment syndrome. Am J Sports Med 1978;6(5):287-90.
