Overview
Compartment syndrome occurs when elevated pressure within a closed muscle compartment reduces blood flow to the tissues, leading to potential damage. It often affects the muscles and other tissues encased in fascia, a tough membrane that does not easily expand.
Relevant Medical Field
This condition is typically treated in the
orthopedic surgery field as it primarily involves the
muscles and
fascia in various body compartments.
What Is Compartment Syndrome?
The body contains various muscle compartments, each surrounded by fascia. These compartments house muscles that perform similar functions. Under normal conditions, these compartments maintain steady pressure. However, when pressure rises due to trauma or other factors, the tissues within—such as muscles, nerves, and blood vessels—become damaged. This is what defines
compartment syndrome.
Causes of Compartment Syndrome
Several factors can lead to increased pressure within a compartment:
- Trauma: External impacts can cause inflammation and swelling in the muscles.
- External compression: Tight bandages, casts, or even stockings can apply excessive pressure.
- Bleeding into the compartment.
- Fluid injection under high pressure into the area.
Interestingly, compartment syndrome can also develop without an apparent increase in compartment pressure. In such cases, it's often caused by impaired blood flow within the compartment due to vascular damage.
Symptoms
The classic symptoms of compartment syndrome include what's commonly referred to as the ‘
5 P’s’:
- Pain: Intense pain, especially when the affected area is lightly touched.
- Pallor: Pale appearance of the skin.
- Paresthesia: Numbness or tingling.
- Paralysis: Inability to move the muscles within the compartment.
- Pulselessness: A lack of detectable pulse in the affected limb.
Additionally, reduced circulation can lead to skin defects and necrosis. Early on, extreme sensitivity to even the slightest touch is common, but in more advanced cases where tissue has already died, the pain may decrease.
Diagnosis and Tests
If compartment syndrome is suspected, measuring the
tissue pressure within the compartment is crucial. Various tools, such as an
IV tube,
three-way stopcock, and
blood pressure monitor, can be used to measure pressure. Specialized devices for tissue pressure measurement are also available. In later stages, muscle necrosis or fibrosis can be detected through
electromyography or
tissue biopsies, which helps differentiate compartment syndrome from simple nerve damage.
Treatment Options
If pressure exceeds 30 mmHg,
emergency fasciotomy (surgical release of the fascia) may be necessary to reduce pressure and prevent permanent damage. In less clear cases, continuous pressure monitoring and regular physical exams can guide treatment decisions. Simple interventions like loosening tight bandages or stockings can also relieve pressure. It is also important to elevate the affected limb to reduce swelling. If blood flow is impaired but pressure is normal, the limb should be elevated at heart level to avoid further complications.
Potential Complications
If the pressure within the compartment is not relieved in time, the tissue can become necrotic. In such cases, while the initial pain may improve, complications arise. Necrotic muscle may harden, causing restricted joint movement. For example, compartment syndrome in the
calf can prevent normal ankle movement, while in the
forearm, it can lead to contractures between the elbow and wrist. A specific type of contracture, known as
Volkmann’s ischemic contracture, can occur after an elbow fracture, causing deformity and functional impairment in the arm. In extreme cases where blood vessel damage is severe, amputation may be required.
Prevention Tips
To prevent compartment syndrome, avoid situations where pressure on muscle compartments can increase. For example, avoid excessive pressure from casts or bandages. If any symptoms of compartment syndrome arise, seek medical care immediately.
Daily Living and Dietary Tips
When outdoor activities result in injury, especially with pain and swelling in the limbs, consider compartment syndrome as a possibility. If severe pain persists and does not improve with basic measures like painkillers or splints, the likelihood of compartment syndrome increases. Loosen any constricting items and keep the limb elevated above the heart. If symptoms do not improve, emergency medical attention is essential.
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