Compartment syndrome

Compartment syndrome Classification and external resources
ICD-10	T 79.6
ICD-9	729.9, 958.8
DiseasesDB	3028
MedlinePlus	001224
eMedicine	emerg/739

Compartment syndrome is an acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use in which increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply, without prompt treatment, may lead to nerve damage and muscle death. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings S00-T14 - Injury (S00-S09 Head ( Superficial Injury of head ( Superficial injury of The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors On the Human body, the limbs can be divided into segments such as the Arm and the Forearm of the Upper limb, and the Thigh and the In Physiology, perfusion is the process of nutritive delivery of Arterial Blood to a Capillary bed in the Biological tissue. There is no single classification system that can describe all the many variations of nerve injury. In Medicine, a myopathy is a neuromuscular Disease in which the Muscle fibers do not function for any one of many reasons resulting in Muscular weakness This condition is most commonly seen in the anterior compartment of the leg and posterior compartment of the leg. The anterior compartment of the leg is supplied by the Deep peroneal nerve and Anterior tibial artery. The posterior compartment of the leg is supplied by the Tibial nerve.

1 Causes
2 Pathophysiology
3 Symptoms and signs
4 Action to take
5 Diagnosis
6 Treatment
7 Complications
8 See also
9 References
10 External links

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. Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, Muscle, and Nervous tissue) Common causes of compartment syndrome include tibial or forearm fractures, ischemic-reperfusion following injury, hemorrhage, vascular puncture, intravenous drug injection, casts, prolonged limb compression, crush injuries and burns. The tibia, shinbone, or shankbone is the larger and stronger of the two Bones in the Leg below the Knee in vertebrates and connects Reperfusion injury refers to damage to tissue caused when Blood supply returns to the tissue after a period of Ischemia.

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.

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, can compromise arteriole perfusion, leading to further tissue ischemia. In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction

The normal mean interstitial tissue pressure is near zero mmHg in non-contracting muscle. If this pressure becomes elevated to 30 mmHg or more, small vessels in the tissue become compressed, which leads to reduced nutrient blood flow i. e. , ischemia and pain. Of particular importance is the difference between compartment pressure and diastolic blood pressure; where diastolic blood pressure exceeds compartment pressure by less than 30mmHg it is considered an emergency.

Untreated compartment syndrome mediated ischemia of the muscles and nerves lead to eventual irreversible damage and death of the tissues within the compartment.

Symptoms and signs

The 6 "Ps" — pain out of proportion to what is expected, paresthesias, passive stretch pain, pulseless, paralysis and pressure on passive extension of the compartment — are said to be useful in recognition of compartment syndrome. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm Paresthesia (pron /ˌpɛɹɪsˈθiʒə/ paraesthesia in British English, pron In Medicine, a person's pulse is the throbbing of their arteries. Paralysed redirects here For other uses see xx Paralysed (disambiguation Paralysis is the complete loss of Muscle function Pressure (symbol 'p' is the force per unit Area applied to an object in a direction perpendicular to the surface Of these only the first two are reliable in the latter stages of compartment syndrome. ^[1]^[2]

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 and is not relieved by analgesia up to and including morphine

Paresthesia (alterated sensation e. Medical uses Morphine can be used as an analgesic in hospital settings to relieve pain in Myocardial infarction pain in g "sticks & needles") in the cutaneous nerves of the affected compartment is another typical sign.

Paralysis of the limb are usually late findings. The compartment may feel very tense and firm as well (pressure).

Note that a lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures and pulse is only affected if the relevant artery is contained within the affected compartment.

Action to take

If you are a patient outside of hospital
Return to the emergency department immediately, or nearest hospital. A hospital is an institution for Health care providing treatment by specialised staff and equipment and often but not always providing for

If you are a physician
Remove any cast or bandage around the limb immediately - all layers should be clear down to skin
Contact a senior orthopaedic or vascular surgeon

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. Fasciotomy is a surgical procedure where the Fascia is cut to relieve tension or pressure (resulting in loss of circulation to an area of tissue or Various recommendations of the intracompartmental pressure are used with some sources quoting >30mmHg^[2] as an indication for fasciotomy while others suggest a >30mmHg difference between intracompartmental pressure and diastolic blood pressure^[3]. The torr (symbol Torr) is a non- SI unit of Pressure defined as 1/760 of an atmosphere. This latter measure may be more sensible in the light of recent advances in permissive hypotension which allow patients to be kept hypotensive in resuscitation.

Treatment

Acute compartment syndrome is a medical emergency requiring immediate surgical treatment known as a fasciotomy to allow the pressure to return to normal.

Subacute compartment syndrome, while not quite as much of an emergency, usually requires urgent surgical treatment similar to acute compartment syndrome.

Chronic compartment syndrome in the lower leg can be treated conservatively or surgically. Conservative treatment includes rest, anti-inflammatories,elevation of the limb and manual decompression. In cases where symptoms persist the condition should be treated by a surgical procedure, subcutaneous fasciotomy or open fasciectomy. Without treatment chronic compartment syndrome can develop into the acute syndrome. A possible complication of surgical intervention for chronic compartment syndrome can be chronic venous insufficiency.

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. Rhabdomyolysis is the rapid breakdown ( Lysis) of Skeletal muscle tissue ( rhabdomyo) due to injury to muscle tissue Renal failure or kidney

References

^ Compartment Syndrome: Fractures, Dislocations, and Sprains: Merck Manual Professional. Retrieved on 2007-11-27. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1095 - Pope Urban II declares the First Crusade at the Council of Clermont
^ ^a ^b emedicine: compartment syndrome. Retrieved on 2008-01-26. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1340 - King Edward III of England is declared King of France.
^ Pocketbook of Orthopaedics and Fractures: Ronald McRae

External links

American Association of Orthopaedic Surgeons Compartment Syndrome

Duke University is a private Research University located in Durham, North Carolina, United States. The Merck Manual of Diagnosis and Therapy, often called simply The Merck Manual, is the world's best-selling medical textbook

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