Compartment Syndrome: Difference between revisions

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== Introduction ==
== Introduction ==
[[File:Compartment Syndrome Picture Wikipedia.jpeg|right|frameless|alt=|Compartment syndrome in leg]]
Acute Compartment Syndrome is a condition in which there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Without prompt treatment, acute compartment syndrome can lead to ischemia and eventually, necrosis.<ref name=":2">Torlincasi AM, Lopez RA, Waseem M. [https://www.ncbi.nlm.nih.gov/books/NBK448124/ Acute compartment syndrome].2017 Available: https://www.ncbi.nlm.nih.gov/books/NBK448124/<nowiki/>(accessed 28.10.2021)</ref> 


Acute Compartment Syndrome is a condition in which there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Without prompt treatment, acute compartment syndrome can lead to ischemia and eventually, necrosis.<ref name=":2">Torlincasi AM, Lopez RA, Waseem M. [https://www.ncbi.nlm.nih.gov/books/NBK448124/ Acute compartment syndrome].2017 Available: https://www.ncbi.nlm.nih.gov/books/NBK448124/<nowiki/>(accessed 28.10.2021)</ref>  
The anterior compartment of the leg is the most common location for compartment syndrome. Other locations in which acute compartment syndrome is seen include the forearm, thigh, buttock, shoulder, hand, and foot.<ref name=":2" />


The anterior compartment of the leg is the most common location for compartment syndrome. This compartment contains the extensor muscles of the toes, the tibialis anterior muscle, the deep peroneal nerve, and the tibial artery. Other locations in which acute compartment syndrome is seen include the forearm, thigh, buttock, shoulder, hand, and foot.<ref name=":2" />
See [[Compartment Syndrome of the Lower Leg]]; [[Compartment Syndrome of the Forearm]]; [[Compartment Syndrome of the Foot|Compartment Syndrome of the Foot.]]


== Etiology ==
== Etiology ==
Acute compartment syndrome can occur without any precipitating trauma but typically occurs after a long bone fracture, with tibial fractures being the most common cause of the condition, followed by distal radius fractures.  
Acute compartment syndrome can occur without any precipitating trauma but typically occurs after a long [[Fracture|bone fracture]], with tibial fractures being the most common cause of the condition, followed by [[Distal Radial Fractures|distal radius fractures.]]


* Seventy-five percent of cases of acute compartment syndrome are associated with fractures. After fractures, the most common cause of acute compartment syndrome is soft tissue injuries.  
* Seventy-five percent of cases of acute compartment syndrome are associated with fractures. After fractures, the most common cause of acute compartment syndrome is soft tissue injuries.
* Other causes of acute compartment syndrome include burns, vascular injuries, crush injuries, drug overdoses, reperfusion injuries, thrombosis, bleeding disorders, infections, improperly placed casts or splints, tight circumferential bandages, penetrating trauma, intense athletic activity, and poor positioning during surgery.  
* Other causes of acute compartment syndrome include [[Burns Overview|burns,]] vascular injuries, crush injuries, [[Substance Use Disorder|drug overdoses]], reperfusion injuries, thrombosis, bleeding disorders, infections, improperly placed casts or [[Splint|splints]], tight circumferential bandages, penetrating trauma, intense athletic activity, and poor positioning during surgery.
* In children, supracondylar fractures of the humerus and both ulnar and radial forearm fractures are associated with compartment syndrome<ref name=":2" />.
* In children, [[Supracondylar Humeral Fracture|supracondylar fractures of the humerus]] and both ulnar and radial forearm fractures are associated with compartment syndrome<ref name=":2" />.
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{{#ev:youtube|IOKixPJi-Ns}}
== Mechanism of Injury / Pathological Process  ==


The connective tissue forming a compartment is not pliable, so when bleeding or swelling occurs within the compartment, the intra-compartmental pressure rises.<ref name="bron 5">Kirsten G B, Elliot A, J Johnstone. Diagnosing acute compartment syndrome. The journal of bone and joint surgery, Vol. 85, N°5, July 2003 A1 (2)http://web.jbjs.org.uk/cgi/reprint/85-B/5/625.pdf Level of evidence: A1</ref><ref name="bron 6">Galanakos S, Sakellariou V I, Kkotoulas H, Sofianos I P. Acute Compartment Syndrome: The significance of immediate diagnosis and the consequences from delayed treatment. E.E.X.O.T, Vol 60: 127-133, 2009 Level of evidence: A1</ref> Normally a non-contracting muscle contains a pressure near zero. If the pressure rises up to 30 mmHg, the vessels will be compressed, resulting in pain and a decrease in blood flow. Lymphatic drainage will activate to prevent increasing interstitial fluid pressure.<ref name="bron 4">Abraham T Rasul Jr. Compartment syndrome. eMedicine. 11 March 2009 A1 (2)http://emedicine.medscape.com/article/307668-overview Level of evidence: A1</ref> Once the effects of lymphatic drainage have reached their maximum, the pressure within the compartments will cause physiological defects, such as a nerve dysfunction and deformation.
== Epidemiology ==
The incidence of acute compartment syndrome is estimated to be 7.3 per 100,000 in males and 0.7 per 100,000 in females, with the majority of cases occurring after trauma. Tibial shaft fracture is the most common cause of acute compartment syndrome (associated with a 1 to 10 percent incidence of acute compartment syndrome)<ref name=":2" />.
 
== Mechanism of Injury / Pathological Process ==
 
The connective tissue forming a compartment is not pliable, so when bleeding or swelling occurs within the compartment, the intra-compartmental pressure rises.<ref name="bron 5">Kirsten G B, Elliot A, J Johnstone. Diagnosing acute compartment syndrome. The journal of bone and joint surgery, Vol. 85, N°5, July 2003 A1 (2)http://web.jbjs.org.uk/cgi/reprint/85-B/5/625.pdf Level of evidence: A1</ref><ref name="bron 6">Galanakos S, Sakellariou V I, Kkotoulas H, Sofianos I P. Acute Compartment Syndrome: The significance of immediate diagnosis and the consequences from delayed treatment. E.E.X.O.T, Vol 60: 127-133, 2009 Level of evidence: A1</ref>
 
Normally a non-contracting muscle contains a pressure near zero.


Haemorrhage or oedema causes the interstitial pressures within the soft tissues to increase, creating possible ischemia by loss of capillary refill.<ref name="bron 7">Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 A1 http://ukpmc.ac.uk/articles/PMC2941579/ Level of evidence: A1</ref> Ischemia starts when the local blood flow can’t fulfill the metabolic demands of the tissues. When a body part is not provided with blood for more than eight hours, the damage is irreversible and may lead to the death of the concerning tissues.<ref name="bron 3">Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. The Association of bone and joint surgeons. 27 may 2009 http://emedicine.medscape.com/article/140002-overview Level of evidence: B</ref>
* If the pressure rises up to 30 mmHg, the vessels will be compressed, resulting in pain and a decrease in blood flow.
*[[Lymphatic System|Lymphatic]] drainage will activate to prevent increasing interstitial fluid pressure.<ref name="bron 4">Abraham T Rasul Jr. Compartment syndrome. eMedicine. 11 March 2009 A1 (2)http://emedicine.medscape.com/article/307668-overview Level of evidence: A1</ref>
* Once the effects of lymphatic drainage have reached their maximum, the pressure within the compartments will cause physiological defects, such as a nerve dysfunction and deformation.


== Clinical Presentation ==
* Haemorrhage or [[Oedema Assessment|oedema]] causes the interstitial pressures within the soft tissues to increase, creating possible ischemia by loss of [[Capillary Refill Test|capillary refill]].<ref name="bron 7">Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 A1 http://ukpmc.ac.uk/articles/PMC2941579/ Level of evidence: A1</ref>
* When a body part is not provided with blood for more than eight hours, the damage is irreversible and may lead to the death of the concerning tissues.<ref name="bron 3">Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. The Association of bone and joint surgeons. 27 may 2009 http://emedicine.medscape.com/article/140002-overview Level of evidence: B</ref>
 
== Clinical Presentation ==


=== Symptoms of Chronic Compartment Syndrome ===
=== Symptoms of Chronic Compartment Syndrome ===
Obtaining an accurate patient history is vital, due to the objective examination often not showing much of note. In a typical case, the patient will present with pain in a compartment of the leg, at the same time, distance and intensity of exercise.<ref>Cook S, Bruce G. Fasciotomy for chronic compartment syndrome in the lower limb. ANZ J Surg 2002; 72(10):720-3</ref> The pain shall continue to increase until it becomes unbearable and the patient stops exercising, causing the pain to subside with rest.  
Obtaining an accurate patient history is vital, due to the objective examination often not showing much of note. In a typical case, the patient will present with [[Pain Assessment|pain]] in a compartment of the leg, at the same time, distance and intensity of exercise.<ref>Cook S, Bruce G. Fasciotomy for chronic compartment syndrome in the lower limb. ANZ J Surg 2002; 72(10):720-3</ref> The pain shall continue to increase until it becomes unbearable and the patient stops exercising, causing the pain to subside with rest.  


*Pain on palpation of involved muscles  
*Pain on palpation of involved muscles
*Pain with passive stretching of muscles  
*Pain with passive [[stretching]] of muscles
*The feeling of firmness of involved compartments  
*The feeling of firmness of involved compartments
*Muscle herniation can be palpated in 40-60% of patients with compartment syndrome (Usually palpated over anterior tibia)  
*Muscle herniation can be palpated in 40-60% of patients with compartment syndrome (Usually palpated over anterior tibia)
*Gait analysis may show excessive overpronation  
*[[Gait|Gait analysis]] may show excessive overpronation
*A neurological exam may show weakness and numbness of the affected compartment<br>
*A neurological exam may show weakness and numbness of the affected compartment<br>
'''Remember the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessness'''<ref name="bron 4" />  
Remember the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessnes'''s'''<ref name="bron 4" />
 
== Diagnostic Procedures  ==


The only way to diagnose a compartment syndrome is to measure the pressure within the compartments of the affected limb.  
== Prognosis ==
The prognosis after treatment of compartment syndrome depends mainly on how quickly the condition is diagnosed and treated. When fasciotomy is done within 6 hours, there is almost 100% recovery of limb function. After 6 hours, there may be residual [[Nerve Injury Rehabilitation|nerve]] damage. Data show that when the fasciotomy is done within 12 hours, only two-thirds of patients have normal limb function. In very delayed cases, the limb may require an [[Amputations|amputation]].  


=== Intra-Compartmental Pressure Monitoring (ICP) ===
== Diagnostic Procedures ==
A catheter connected to a transducer is usually introduced into the compartment to be measured. Measurement of the compartment pressure can be performed at rest, as well as during and after exercise. With the acute syndrome, typical ranges are from 30-45 mmHg at rest.<ref name="bron 5" /> This objective method can provide a continuous recording of pressure measurement for between 16 and 24 hours.


The normal ICP ranges from zero to 10 mmHg. When the pressure is near 30 mmHg below the diastolic pressure, a surgeon will perform a fasciotomy.<ref name="bron 4" /> Time is a very significant parameter, but very difficult to measure.<ref name="bron 6" /> Decompression within 6 hours will result in a full recovery. If more than 12 hours pass without any medical treatment, long term disability is most likely.<br>
# Intra-Compartmental Pressure Monitoring (ICP): Not required but can aid in diagnosis if uncertainty exists. Compartment pressures are often measured with a manometer, a device that detects intracompartmental pressure by measuring the resistance that is present when a saline solution is injected into the compartment. Another method employs a slit catheter, whereby a catheter is placed within the compartment, and the pressure measured with an arterial line transducer. <br>
# Less Invasive Measurement Techniques
#*Laser Doppler ultrasound
#*Methoxy isobutyl isonitrile enhanced magnetic resonance imaging ([[MRI Scans|MRI]])
#*Phosphate-nuclear magnetic resonance (NMR) spectroscopy


=== Less Invasive Measurement Techniques ===
== Outcome Measures ==
*Laser Doppler ultrasound
*[[Lower Extremity Functional Scale (LEFS)|Lower Extremity Functional Scale]] (LEFS)<ref name=":0">Tjeerdsma J. Outcome of a specific compartment fasciotomy versus a complete compartment fasciotomy of the leg in one patient with bilateral anterior chronic exertional compartment syndrome: a case report. The Journal of Foot and Ankle Surgery. 2016 Sep 1;55(5):1027-34.</ref>
*Methoxy isobutyl isonitrile enhanced magnetic resonance imaging (MRI)  
*[[Foot and Ankle Ability Measure]] (FAAM)<ref name=":0" />
*Phosphate-nuclear magnetic resonance (NMR) spectroscopy
*[[Visual Analogue Scale]]<ref name=":1">Meulekamp MZ, van der Wurff P, van der Meer A, Lucas C. Identifying prognostic factors for conservative treatment outcomes in servicemen with chronic exertional compartment syndrome treated at a rehabilitation center. Military Medical Research. 2017 Dec;4(1):36.</ref>
*[[Patient Specific Functional Scale]]<ref name=":1" />
For more see [[Outcome Measures|Outcome Measures Database]]


== Outcome Measures  ==
== Management / Interventions ==
* [[Lower Extremity Functional Scale (LEFS)|Lower Extremity Functional Scale]] (LEFS)<ref name=":0">Tjeerdsma J. Outcome of a specific compartment fasciotomy versus a complete compartment fasciotomy of the leg in one patient with bilateral anterior chronic exertional compartment syndrome: a case report. The Journal of Foot and Ankle Surgery. 2016 Sep 1;55(5):1027-34.</ref>
[[File:1024px-Compartment syndrome with fasciotomy procedure 01.jpeg|right|frameless|355x355px]]
* [[Foot and Ankle Ability Measure]] (FAAM)<ref name=":0" />
In the event of a diagnosis of Compartment syndrome (when there is a intra-compartment pressure of &gt;30 mmHg<ref name="p1">Von Schroeder HP et al. Definitions and terminology of compartment syndrome and Volkmann's ischemic contracture of the upper extremity. Hand Clin. 1998 Aug;14(3):331-4.</ref><ref name="p2">Jim Clover. Sports medicine essentials, core concepts in athletic training. 2nd edition. 2010</ref>) immediate surgical fasciotomy is needed to reduce the intracompartmental pressure. 
* [[Visual Analogue Scale]]<ref name=":1">Meulekamp MZ, van der Wurff P, van der Meer A, Lucas C. Identifying prognostic factors for conservative treatment outcomes in servicemen with chronic exertional compartment syndrome treated at a rehabilitation center. Military Medical Research. 2017 Dec;4(1):36.</ref>
* [[Patient Specific Functional Scale]]<ref name=":1" />
For more see [[Outcome Measures|Outcome Measures Database]])


== Management / Interventions  ==
Image 2: Compartment syndrome with fasciotomy procedure  
In the event of a diagnosis of Compartment syndrome (when there is a intra-compartment pressure of &gt;30 mmHg<ref name="p1">Von Schroeder HP et al. Definitions and terminology of compartment syndrome and Volkmann's ischemic contracture of the upper extremity. Hand Clin. 1998 Aug;14(3):331-4.</ref><ref name="p2">Jim Clover. Sports medicine essentials, core concepts in athletic training. 2nd edition. 2010</ref>, an urgent fasciotomy is recommended, &nbsp;Raised ICP threatens the viability of the limb and CS (compartment syndrome) represents a true medical emergency. Thus, the need for decompression by removal of all dressing down to skin, followed by fasciotomy- Surgical opening of the fascia around the muscles to make more place for the structures inside.


Experimental evidence has shown:
* The ideal timeframe for fasciotomy is within six hours of injury
*The circular cast can substantiate the adverse effects of raised ICP
* Fasciotomy is not recommended after 36 hours following injury. When tissue pressure remains elevated for that amount of time, irreversible damage may occur, and fasciotomy may not be beneficial in this situation.  
*Splitting of the cast on one side leads to an average fall in ICP 30%
*Splitting of the cast on both sides leads to an average fall in ICP 65%
*Complete removal of the cast reduced the pressure by another 15%
In these particular cases which the diagnosis is being considered and in those in whom resuscitation is proceeding, the following steps should be performed:
*Ensure the patient is normotensive, as hypotension reduces perfusion pressure and contributes in the anoxemia and the consequent tissue injury.
*Remove any circumferential or constricting bandages (even bloody bandages).
*Maintain the limb at heart level as elevation reduces the arterio-venous pressure gradient.
*Give supplemental oxygen to ensure optimal saturation.
Several surgical approaches have been tried. The surgical goal is one and only; the adequate decompressive for the viability of the limb or the prevention of permanent disability. The cosmetic or the location and lengths of incisions should not be considered. In treatment of CS there is no place for short cosmetic incisions. Surgical incisions less than 15cm may be lead in inadequate decompression.


After decompression, delayed primary closure can be performed when swelling has subsided, however this may be difficult or unachievable due to skin retraction. Various methods and materials have been described using the elastic properties of the skin to aid wound closure. If the wound edges cannot be approximated, skin grafting may be required.
After a fasciotomy is performed and swelling dissipates, a skin graft is commonly used for incision closure. Patients must be closely monitored for complications which include infection, acute renal failure, and rhabdomyolysis.  


Intamedullary nailing may increase ICP, fact that was taken into consideration seriously at the first years of nailing application and it was thought that nailing should be delayed for up to 7 days. However further research&nbsp;has shown that during reaming the pressure may rise to 180 mmHg, but it falls back to normal after removing the reamer. Similarly, the application of traction also increases the pressure but this immediately drops with release of the traction. Controversy still exists if monitoring should be performed during intamedullary nailing. Mcqueen et al suggested routine monitoring if facilities are available. Others have suggested that this may lead to over treatment and unnecessary fasciotomies<ref name="p3">H.J. Seddon. Volkmann’s contracture: Treatment by excision of the infarct. London, England; from the institute of orthopaedics.</ref>.
If necrosis occurs before fasciotomy is performed, there is a high likelihood of infection which may require amputation. If infection occurs, debridement is necessary to prevent systemic spread or other complications<ref name=":2" />.  


Physiotherapy role in the treatment of the condition is vital, with or without surgical intervention. The physiotherapist may employ modalities that will improve range of motion, strength of the affected muscles, function and relief pain. [[Compartment Syndrome of the Lower Leg|see...]]
== Physiotherapy ==
Physiotherapy role in the treatment of the condition is vital, with or without surgical intervention. The physiotherapist may employ modalities that will improve range of motion, strength of the affected muscles, function and relief pain.  


[[Compartment Syndrome of the Foot|Also read...]]
See highlighted links in Introduction for site specific Physiotherapy


== Differential Diagnosis  ==
== Differential Diagnosis  ==
Line 85: Line 87:
These common pathologies may give the same pain characteristics or symptoms in the lower limbs:<ref name="bron 20">http://www.physioadvisor.com.au/10513350/compartment-syndrome-chronic-compartment-syndrom.htm</ref>  
These common pathologies may give the same pain characteristics or symptoms in the lower limbs:<ref name="bron 20">http://www.physioadvisor.com.au/10513350/compartment-syndrome-chronic-compartment-syndrom.htm</ref>  


*[[Shin-splints|shin splints]] (medial tibial stress syndrome)  
*[[Medial Tibial Stress Syndrome|shin splints]] (medial tibial stress syndrome)  
*[[Stress Fractures|stress fractures]]  
*[[Stress Fractures|stress fractures]]  
*[[Leg and Foot Stress Fractures|fascial defects]]  
*[[Leg and Foot Stress Fractures|fascial defects]]  

Latest revision as of 11:45, 3 August 2022

Original Editor - Racheal Lowe Top Contributors - Alex Palmer, Lucinda hampton, Jessie Tourwe, Rachael Lowe, Kim Jackson, Admin, Uchechukwu Chukwuemeka, Manisha Shrestha, Karen Wilson and Wanda van Niekerk




Introduction[edit | edit source]

Acute Compartment Syndrome is a condition in which there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Without prompt treatment, acute compartment syndrome can lead to ischemia and eventually, necrosis.[1]

The anterior compartment of the leg is the most common location for compartment syndrome. Other locations in which acute compartment syndrome is seen include the forearm, thigh, buttock, shoulder, hand, and foot.[1]

See Compartment Syndrome of the Lower Leg; Compartment Syndrome of the Forearm; Compartment Syndrome of the Foot.

Etiology[edit | edit source]

Acute compartment syndrome can occur without any precipitating trauma but typically occurs after a long bone fracture, with tibial fractures being the most common cause of the condition, followed by distal radius fractures.

  • Seventy-five percent of cases of acute compartment syndrome are associated with fractures. After fractures, the most common cause of acute compartment syndrome is soft tissue injuries.
  • Other causes of acute compartment syndrome include burns, vascular injuries, crush injuries, drug overdoses, reperfusion injuries, thrombosis, bleeding disorders, infections, improperly placed casts or splints, tight circumferential bandages, penetrating trauma, intense athletic activity, and poor positioning during surgery.
  • In children, supracondylar fractures of the humerus and both ulnar and radial forearm fractures are associated with compartment syndrome[1].

Epidemiology[edit | edit source]

The incidence of acute compartment syndrome is estimated to be 7.3 per 100,000 in males and 0.7 per 100,000 in females, with the majority of cases occurring after trauma. Tibial shaft fracture is the most common cause of acute compartment syndrome (associated with a 1 to 10 percent incidence of acute compartment syndrome)[1].

Mechanism of Injury / Pathological Process[edit | edit source]

The connective tissue forming a compartment is not pliable, so when bleeding or swelling occurs within the compartment, the intra-compartmental pressure rises.[2][3]

Normally a non-contracting muscle contains a pressure near zero.

  • If the pressure rises up to 30 mmHg, the vessels will be compressed, resulting in pain and a decrease in blood flow.
  • Lymphatic drainage will activate to prevent increasing interstitial fluid pressure.[4]
  • Once the effects of lymphatic drainage have reached their maximum, the pressure within the compartments will cause physiological defects, such as a nerve dysfunction and deformation.
  • Haemorrhage or oedema causes the interstitial pressures within the soft tissues to increase, creating possible ischemia by loss of capillary refill.[5]
  • When a body part is not provided with blood for more than eight hours, the damage is irreversible and may lead to the death of the concerning tissues.[6]

Clinical Presentation[edit | edit source]

Symptoms of Chronic Compartment Syndrome[edit | edit source]

Obtaining an accurate patient history is vital, due to the objective examination often not showing much of note. In a typical case, the patient will present with pain in a compartment of the leg, at the same time, distance and intensity of exercise.[7] The pain shall continue to increase until it becomes unbearable and the patient stops exercising, causing the pain to subside with rest.

  • Pain on palpation of involved muscles
  • Pain with passive stretching of muscles
  • The feeling of firmness of involved compartments
  • Muscle herniation can be palpated in 40-60% of patients with compartment syndrome (Usually palpated over anterior tibia)
  • Gait analysis may show excessive overpronation
  • A neurological exam may show weakness and numbness of the affected compartment

Remember the 5 P’s: Pain, Pallor, Paresthesia, Paralysis, Pulselessness[4]

Prognosis[edit | edit source]

The prognosis after treatment of compartment syndrome depends mainly on how quickly the condition is diagnosed and treated. When fasciotomy is done within 6 hours, there is almost 100% recovery of limb function. After 6 hours, there may be residual nerve damage. Data show that when the fasciotomy is done within 12 hours, only two-thirds of patients have normal limb function. In very delayed cases, the limb may require an amputation.

Diagnostic Procedures[edit | edit source]

  1. Intra-Compartmental Pressure Monitoring (ICP): Not required but can aid in diagnosis if uncertainty exists. Compartment pressures are often measured with a manometer, a device that detects intracompartmental pressure by measuring the resistance that is present when a saline solution is injected into the compartment. Another method employs a slit catheter, whereby a catheter is placed within the compartment, and the pressure measured with an arterial line transducer.
  2. Less Invasive Measurement Techniques
    • Laser Doppler ultrasound
    • Methoxy isobutyl isonitrile enhanced magnetic resonance imaging (MRI)
    • Phosphate-nuclear magnetic resonance (NMR) spectroscopy

Outcome Measures[edit | edit source]

For more see Outcome Measures Database

Management / Interventions[edit | edit source]

1024px-Compartment syndrome with fasciotomy procedure 01.jpeg

In the event of a diagnosis of Compartment syndrome (when there is a intra-compartment pressure of >30 mmHg[10][11]) immediate surgical fasciotomy is needed to reduce the intracompartmental pressure.

Image 2: Compartment syndrome with fasciotomy procedure

  • The ideal timeframe for fasciotomy is within six hours of injury
  • Fasciotomy is not recommended after 36 hours following injury. When tissue pressure remains elevated for that amount of time, irreversible damage may occur, and fasciotomy may not be beneficial in this situation.

After a fasciotomy is performed and swelling dissipates, a skin graft is commonly used for incision closure. Patients must be closely monitored for complications which include infection, acute renal failure, and rhabdomyolysis.

If necrosis occurs before fasciotomy is performed, there is a high likelihood of infection which may require amputation. If infection occurs, debridement is necessary to prevent systemic spread or other complications[1].

Physiotherapy[edit | edit source]

Physiotherapy role in the treatment of the condition is vital, with or without surgical intervention. The physiotherapist may employ modalities that will improve range of motion, strength of the affected muscles, function and relief pain.

See highlighted links in Introduction for site specific Physiotherapy

Differential Diagnosis[edit | edit source]

These common pathologies may give the same pain characteristics or symptoms in the lower limbs:[12]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Torlincasi AM, Lopez RA, Waseem M. Acute compartment syndrome.2017 Available: https://www.ncbi.nlm.nih.gov/books/NBK448124/(accessed 28.10.2021)
  2. ↑ Kirsten G B, Elliot A, J Johnstone. Diagnosing acute compartment syndrome. The journal of bone and joint surgery, Vol. 85, N°5, July 2003 A1 (2)http://web.jbjs.org.uk/cgi/reprint/85-B/5/625.pdf Level of evidence: A1
  3. ↑ Galanakos S, Sakellariou V I, Kkotoulas H, Sofianos I P. Acute Compartment Syndrome: The significance of immediate diagnosis and the consequences from delayed treatment. E.E.X.O.T, Vol 60: 127-133, 2009 Level of evidence: A1
  4. ↑ 4.0 4.1 Abraham T Rasul Jr. Compartment syndrome. eMedicine. 11 March 2009 A1 (2)http://emedicine.medscape.com/article/307668-overview Level of evidence: A1
  5. ↑ Tucker Alicia K. Chronic exertional compartment syndrome of the leg. Current Reviews in Musculoskeletal Medicine. 2 September 2010 A1 http://ukpmc.ac.uk/articles/PMC2941579/ Level of evidence: A1
  6. ↑ Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. The Association of bone and joint surgeons. 27 may 2009 http://emedicine.medscape.com/article/140002-overview Level of evidence: B
  7. ↑ Cook S, Bruce G. Fasciotomy for chronic compartment syndrome in the lower limb. ANZ J Surg 2002; 72(10):720-3
  8. ↑ 8.0 8.1 Tjeerdsma J. Outcome of a specific compartment fasciotomy versus a complete compartment fasciotomy of the leg in one patient with bilateral anterior chronic exertional compartment syndrome: a case report. The Journal of Foot and Ankle Surgery. 2016 Sep 1;55(5):1027-34.
  9. ↑ 9.0 9.1 Meulekamp MZ, van der Wurff P, van der Meer A, Lucas C. Identifying prognostic factors for conservative treatment outcomes in servicemen with chronic exertional compartment syndrome treated at a rehabilitation center. Military Medical Research. 2017 Dec;4(1):36.
  10. ↑ Von Schroeder HP et al. Definitions and terminology of compartment syndrome and Volkmann's ischemic contracture of the upper extremity. Hand Clin. 1998 Aug;14(3):331-4.
  11. ↑ Jim Clover. Sports medicine essentials, core concepts in athletic training. 2nd edition. 2010
  12. ↑ http://www.physioadvisor.com.au/10513350/compartment-syndrome-chronic-compartment-syndrom.htm


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