Compartment Syndrome By Patti Hamilton

DEFINITION Compartment syndrome involves the compression of nerves and blood vessels within an enclosed space. This leads to impaired blood flow, muscle and nerve damage.

CAUSES Swelling in a compartment will lead to increasing pressure in that compartment, which will compress the muscles, blood vessel and nerves. If the pressure is high enough blood flow to the compartment will be blocked. This can lead to permanent injury to the muscles and nerves ( within 6 hrs). If the pressure last long enough, the limb may die and need to be amputated( within 24-48 hrs).

INCIDENCE AND RISK FACTORS Swelling associated with high energy trauma- car accident, crush injury, or surgery. Tight bandages or casts. Repetitive activities - running Most common in the lower leg and forearm, but can occur in the hand, foot, thigh and upper arm.

SUBJECTIVE ASSESSMENT The hallmark symptom of compartment syndrome is severe pain that does not respond to elevation or pain medicine. The patient will complain of sharp pain that increases with passive movement of the hand or foot. Numbness or tingling in the affected extremity is common. In advanced cases, there may be decreased sensation, weakness, and paleness of the skin.

OBJECTIVE ASSESSMENT Severe pain will occur when a muscle running through a compartment is passively moved. The skin overlying the compartment will be tensely swollen, shiny, and cool to the touch. Assessment of skin color may reveal pallor or cyanosis. Cap. Refill time will be increased with gentle palpation of the extremity. Monitor vital signs.

MEDICAL MANAGEMENT Surgery is usually required. A fasciotomy – incision into the fascia – to relieve the pressure and allow return of normal blood flow to the area. This needs to be done immediately, within 30 minutes. Incision is left open to heal by granulation, covered by a sterile dressing. If a cast or bandage is the problem, the dressing or cast should be loosened or cut down to relieve the pressure.

NURSING INTERVENTIONS Administration of analgesics. Elevate the limb – no higher than heart level. Application of cold packs. Removal of any restricting material. Observe for signs of infections. Encourage patients to verbalize fears and emotional needs. Proper postioning and alignment to prevent permanent contracture known as Volkmann’s Contracture ( claw hand, flexion of wrist and finger, atrophy of forearm).

PREVENTION Not preventable – but being aware of this condition and early diagnosis will help prevent many of the complications. People placed in casts need to be made aware of the risk of swelling. To seek immediate medical attention if they have increasing pain under the cast despite elevation and pain medicine.

PROGNOSIS If the diagnosis is made promptly and surgical release performed the outlook is excellent for recovery of the muscles and nerves inside the compartment. If there is a delay in diagnosis, there can be permanent damage. This is most common when the injured person is unconscious or heavily sedated and incapable of complaining. Permanent injury can occur after 12-24 hours of compression.