Compartment SyndromeN540B Spring 2007Mary Gaspar

Overview of Compartment SyndromeCompartment syndrome occurs when blood supply is dramatically reduced to muscles in a closed body space, known as a compartment. Compartments are found in the hand, forearm, upper arm, abdomen, buttock and leg.The muscles most frequently involved are those on the front of the lower leg or palm side of the forearm.

Common causes of CS include:Bleeding from a bone fracture Burn escharCasts applied too tightly Crush injuries Leaking of IVF into the compartmentSeizures that involve the muscles in a compartmentSnake biteSwelling of the muscle itself

Whats going on in the body?Compartments are groups of muscles surrounded by inelastic fascia.Increased pressure within a muscle compartment causes decreased blood supply to affected muscles. Any swelling of muscles leaves no room for expansion and blood supply is progressively shut off.If affected muscles are deprived of blood supply for > 6 hours, nerve and muscle tissue can be permanently damaged.

Hallmark Symptoms of Compartment SyndromeSevere pain or parasthesia disproportionate to the injuryIncrease in pain after pain medication has been administered.In severe cases there may be decreased sensation, weakness and paleness of the skin.

History and Physical Exam: Look for the 6 PsSubjective info:PainPressureParasthesia

Objective info:PallorPulselessnessParesis

Why is compartment syndrome an emergency? If not diagnosed and treated promptly there can be permanent nerve injury and loss of muscle function.Permanent nerve injury can occur after 12-24 hours.In severe cases limbs may need to be amputated because all of the muscles in the compartment have died from lack of O2.

DiagnosisA swollen limb, tense on palpation, in an intrinsic minimus position strongly indicates compartment syndrome. Diagnosis is based on high degree of clinical suspicion

TreatmentA surgical procedure known as fasciotomy may be used to open the membrane leading to the affected muscles. Pressure is relieved and the blood flow can return to normal. Often the skin needs to be left open for a few days. It can be closed with sutures or a skin graft after swelling diminishes.

PrognosisAccurate and prompt diagnosis is necessary to assure a good outcome.Only 8% of patients will regain function if surgery is delayed.Little or no return of function can be expected if dx and tx are delayed.Surgery performed days after injury contraindicated due to severe infection and difficulty in managing necrotic muscle.If surgery performed within 12 hours after onset of acute CS, prognosis is good.

References:http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=287&topcategory=General%20Informationhttp://www.emedicine.com/EMERG/topic739.htmhttp://www.rice.edu/~jenky/sports/cmpt.htmlhttp://health.allrefer.com/health/compartment-syndrome-info.html

Test QuestionIva Tript fell in her home and fractured her leg. She was found by her neighbor 36 hours after her fall. Her lower extremity was pale, numb and without peripheral pulses. Which of the following constitutes appropriate treatment for Ivas diagnosis of compartment syndrome?A. Cast her leg, give her medicine for pain and have her return for follow-up in 1 week.Fasciotomy to be performed within 12 hours of hospital admission and her prognosis for recovery of function is good.Surgery to regain function of her leg is no longer possible. Her leg must be amputated.Iva is a candidate for surgery but should be informed that her chances of regaining function are about 8%.