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Compartment Syndrome

Updated : September 16, 2022





Background

A compartment is a group of nerves, muscles, and blood vessels. A thin film membrane known as a fascia lies over each compartment which keeps the muscles in order.

Compartment syndrome is a painful condition caused by increased intracompartmental pressure; this pressure causes a reduction in blood flow, preventing oxygen from reaching neurons and muscle cells, which can cause severe damage to the muscle.

Compartment syndrome most commonly affects the lower leg. However, it can affect other areas of the leg, arms, abdomen, feet, and glutes.

Epidemiology

The incidence in males is estimated to be 7.3 per 100,000, whereas the female incidence is 0.7 per 100,000, with most cases developing after trauma. Acute compartment syndrome is more common in men under the age of 35 because of the presence of a relatively larger intracompartmental muscle mass, and they are more likely to be involved in high-powered trauma.

Patients with bleeding disorders, such as hemophilia, are more likely to develop this condition. In pediatric patients with leukemia, this condition has been documented in the absence of an acute triggering trauma.

Chronic Compartmental Syndrome involving the upper extremity is observed mainly in professional athletes, rowers, and marching militants; runners are associated with the lower extremity.

Anatomy

Pathophysiology

Compartment syndrome occurs when edema or bleeding occurs within a compartment. Fascia is a thin, inelastic sheet of connective tissue that surrounds muscle compartments, limiting their ability to expand rapidly.

Since the fascia does not expand, it puts pressure on the compartment’s capillaries, nerves, and muscles. Blood flow to muscle and nerve cells is disturbed. Nerve and muscle cells are damaged if they do not receive a constant supply of oxygen and nutrients.

The tissue damage is irreversible in almost all cases, causes permanent damage, and could be life threatening. The most prevalent region for compartment syndrome is the anterior compartment of the leg.

Acute Compartment Syndrome: When the equilibrium between the arterial inflow and venous flow is disturbed, the intracompartmental pressure increases and reduces the venous outflow.

Thus, this causes an increase in the pressure of the venous capillary. This reduction of the venous outflow results in decreased oxygen to the tissues resulting in ischemia.

If the scarcity of oxygen is persistent irreversible damage occurs. The normal pressure within a compartment is 10mmHg. In acute compartment syndrome, the pressure increases more than 30mmHg.

Chronic Compartment Syndrome: A reversible increase in pressure within an inelastic fascial compartment causes poor tissue perfusion, which causes pain and other neurologic symptoms. Symptoms usually subside on rest with no long-term effects on the tissue affected.

Etiology

Acute Compartment Syndrome: A tibial fracture is the most common cause of acute compartment syndrome, followed by a distal radius fracture; however, the condition can also develop without prior trauma. Soft tissue injuries are the most frequent cause of acute compartment syndrome.

Burns, bleeding disorders, infections, reperfusion injuries, incorrectly applied casts or splints, crush injuries, uncomfortably tight circumferential bandages, penetrating trauma, vascular injuries, drug overdoses, thrombosis, vigorous exercise, and improper positioning during surgery are additional causes of acute compartment syndrome.

Chronic Compartment Syndrome: Exercise causes the pain and edema associated with chronic compartment syndrome. People who engage in repetitive motion activities are more susceptible to chronic compartment syndrome. It is usually relieved by discontinuing the activity, which is not usually dangerous.

Genetics

Prognostic Factors

If the pressure is not removed promptly, the situation can result in permanent impairment, amputation, and death. Chronic compartment syndrome can reoccur if you resume vigorous or repetitive exercise

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK448124/

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Compartment Syndrome

Updated : September 16, 2022




A compartment is a group of nerves, muscles, and blood vessels. A thin film membrane known as a fascia lies over each compartment which keeps the muscles in order.

Compartment syndrome is a painful condition caused by increased intracompartmental pressure; this pressure causes a reduction in blood flow, preventing oxygen from reaching neurons and muscle cells, which can cause severe damage to the muscle.

Compartment syndrome most commonly affects the lower leg. However, it can affect other areas of the leg, arms, abdomen, feet, and glutes.

The incidence in males is estimated to be 7.3 per 100,000, whereas the female incidence is 0.7 per 100,000, with most cases developing after trauma. Acute compartment syndrome is more common in men under the age of 35 because of the presence of a relatively larger intracompartmental muscle mass, and they are more likely to be involved in high-powered trauma.

Patients with bleeding disorders, such as hemophilia, are more likely to develop this condition. In pediatric patients with leukemia, this condition has been documented in the absence of an acute triggering trauma.

Chronic Compartmental Syndrome involving the upper extremity is observed mainly in professional athletes, rowers, and marching militants; runners are associated with the lower extremity.

Compartment syndrome occurs when edema or bleeding occurs within a compartment. Fascia is a thin, inelastic sheet of connective tissue that surrounds muscle compartments, limiting their ability to expand rapidly.

Since the fascia does not expand, it puts pressure on the compartment’s capillaries, nerves, and muscles. Blood flow to muscle and nerve cells is disturbed. Nerve and muscle cells are damaged if they do not receive a constant supply of oxygen and nutrients.

The tissue damage is irreversible in almost all cases, causes permanent damage, and could be life threatening. The most prevalent region for compartment syndrome is the anterior compartment of the leg.

Acute Compartment Syndrome: When the equilibrium between the arterial inflow and venous flow is disturbed, the intracompartmental pressure increases and reduces the venous outflow.

Thus, this causes an increase in the pressure of the venous capillary. This reduction of the venous outflow results in decreased oxygen to the tissues resulting in ischemia.

If the scarcity of oxygen is persistent irreversible damage occurs. The normal pressure within a compartment is 10mmHg. In acute compartment syndrome, the pressure increases more than 30mmHg.

Chronic Compartment Syndrome: A reversible increase in pressure within an inelastic fascial compartment causes poor tissue perfusion, which causes pain and other neurologic symptoms. Symptoms usually subside on rest with no long-term effects on the tissue affected.

Acute Compartment Syndrome: A tibial fracture is the most common cause of acute compartment syndrome, followed by a distal radius fracture; however, the condition can also develop without prior trauma. Soft tissue injuries are the most frequent cause of acute compartment syndrome.

Burns, bleeding disorders, infections, reperfusion injuries, incorrectly applied casts or splints, crush injuries, uncomfortably tight circumferential bandages, penetrating trauma, vascular injuries, drug overdoses, thrombosis, vigorous exercise, and improper positioning during surgery are additional causes of acute compartment syndrome.

Chronic Compartment Syndrome: Exercise causes the pain and edema associated with chronic compartment syndrome. People who engage in repetitive motion activities are more susceptible to chronic compartment syndrome. It is usually relieved by discontinuing the activity, which is not usually dangerous.

If the pressure is not removed promptly, the situation can result in permanent impairment, amputation, and death. Chronic compartment syndrome can reoccur if you resume vigorous or repetitive exercise

https://www.ncbi.nlm.nih.gov/books/NBK448124/

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