Treatment of compartment syndrome includes which of the following measures?
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Compartment syndrome is increased tissue pressure within a closed fascial space, resulting in tissue ischemia. The earliest symptom is pain out of proportion to the severity of injury. Diagnosis is clinical and usually confirmed by measuring compartment pressure. Treatment is fasciotomy. Show
Compartment syndrome is a self-perpetuating cascade of events. It begins with the tissue edema that normally occurs after injury (eg, because of soft-tissue swelling or a hematoma). If edema develops within a closed fascial compartment, typically in the anterior or posterior compartments of the leg, there is little room for tissue expansion, so interstitial (compartment) pressure increases. As compartment pressure exceeds the normal capillary pressure of about 8 mm Hg, cellular perfusion slows and may ultimately stop. (NOTE: Because 8 mm Hg is much lower than arterial pressure, cellular perfusion can stop long before pulses disappear.) Resultant tissue ischemia further worsens edema in a vicious circle. As ischemia progresses, muscles necrose, sometimes leading to rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue. Symptoms and signs include muscle weakness, myalgias, and reddish-brown urine, although this triad is... read more , infections, and hyperkalemia; these complications can cause loss of limb and, if untreated, death. Hypotension or arterial insufficiency can compromise tissue perfusion with even mildly elevated compartment pressures, causing or worsening compartment syndrome. Contractures may develop after necrotic tissue heals. Compartment syndrome is mainly a disorder of the extremities and is most common in the lower leg and the forearm. However, compartment syndrome can also occur in other locations (eg, upper arm, abdomen, buttock). Etiology of Compartment SyndromeCommon causes of compartment syndrome include
Rare causes include snakebites, burns, severe exertion, drug overdose (of heroin or cocaine), casts, tight bandages, and other rigid circumferential devices that limit swelling and thus increase compartment pressure. Prolonged pressure on a muscle during coma may cause rhabdomyolysis. Symptoms and Signs of Compartment SyndromeThe earliest symptom of compartment syndrome is
It is typically out of proportion to the severity of the apparent injury and is exacerbated by passive stretching of the muscles within the compartment (eg, for the anterior leg compartment, by passive ankle plantar flexion and toe flexion, which stretches the anterior compartment muscles). Pain, one of the 5 Ps of tissue ischemia, is followed by the other 4: paresthesias, paralysis, pallor, and pulselessness. Compartments may feel tense when palpated. Pearls & Pitfalls
Diagnosis of Compartment Syndrome
Diagnosis of compartment syndrome must be made and treatment started before pallor or pulselessness develops, indicating necrosis. (See also How To Measure Compartment Pressure in a Forearm How To Measure Compartment Pressure in a Forearm Compartment pressure is measured to assist in diagnosing compartment syndrome. Measurement of compartment pressure is a hospital-based procedure that requires considerable technical skill; an... read more and How To Measure Compartment Pressure in the Lower Leg How To Measure Compartment Pressure in the Lower Leg Compartment pressure is measured to assist in diagnosing compartment syndrome. Measurement of compartment pressure is a hospital-based procedure that requires considerable technical skill; an... read more .) Clinical evaluation is difficult for several reasons:
How To Measure Compartment Pressure in the Forearm  VIDEO How To Measure Compartment Pressure in the Lower Leg VIDEO Thus, in patients with at-risk injuries, clinicians must have a low threshold for measuring compartment pressure (normal ≤ 8 mm Hg), usually with a commercially available pressure monitor. Compartment syndrome is confirmed if compartmental pressure is more than about 30 mm Hg or within about 30 mm Hg of diastolic blood pressure (BP). (See also the American Academy of Orthopaedic Surgeons clinical practice guideline for the management of acute compartment syndrome What is the main treatment for compartment syndrome?Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency fasciotomy. The doctor or surgeon makes an incision to cut open your skin and fascia surrounding the muscles to immediately relieve the pressure inside the muscle compartment.
How is compartment syndrome diagnosed and treated?If symptoms point to chronic compartment syndrome, your doctor performs a compartment pressure test before and after a workout to compare pressure levels. If either or both readings indicate high pressure, you have chronic compartment syndrome. Your doctors may recommend medical treatment or surgery.
What are the 5 P's of compartment syndrome?Common Signs and Symptoms: The "5 P's" are oftentimes associated with compartment syndrome: pain, pallor (pale skin tone), paresthesia (numbness feeling), pulselessness (faint pulse) and paralysis (weakness with movements). Numbness, tingling, or pain may be present in the entire lower leg and foot.
What interventions alleviate compartment syndrome?Acute compartment syndrome must get immediate treatment. A surgeon will perform an operation called a fasciotomy. To relieve pressure, the surgeon makes an incision (cut) through the skin and the fascia (compartment cover). After the swelling and pressure go away, the surgeon will close the incision.
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