COMPARTMENT SYNDROME

INTRODUCTION Compartment syndrome (CS) is a limb- threatening 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. abdomen

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. weakness

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). Diagnosed based on the history (was there trauma?) and physical exam findings (extreme pain and swelling). Compartment pressure testing. Compartment pressure testing.

DIAGNOSIS OF CHRONIC COMPARTMENT SYNDROME x-raysx-rays : to make sure do not have a stress fracture. x-rays 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.

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. COMPARTMENT PRESSURE TESTING

Clinical Diagnosis (Taken pre/post exercise w/ slit catheter under local anesthesia) 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 NSAIDSStretching Release tighten bandage Fasciotomy of all involved compartments > 30 mmHg

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