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Compartment syndrome is an acute medical problem following injury or surgery in which increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply, leading to nerve damage and muscle death without prompt treatment.
Additional recommended knowledge
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. 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.
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.
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.
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.
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
If any of these occur, return to the emergency department immediately, or nearest hospital.
CCS can be tested for by gauging the pressure within the muscle compartments. If the pressure is sufficiently high, a fasciotomy may be required.
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, and stretching. 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.
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.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Compartment_syndrome". A list of authors is available in Wikipedia.|