Information about Compartment Syndrome

Compartment syndrome
Classification & external resources

ICD-10	T79.6
ICD-9	729.9, 958.8
DiseasesDB	3028
MedlinePlus	001224
eMedicine	emerg/739  pmr/33 sports/26
MeSH	C05.651.180

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.

Causes

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.

Pathophysiology

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 25 mmHg (range 20–30 mmHg), and if it is over 50–60 mmHg or below 10mmHg (or below the diastolic blood pressure minus 20–30 mmHg) functional tissue changes can occur e.g tissue necrosis. ^[1]. Arteries and arterioles are stable at these pressures, however the tissues within the compartment dependent on the capillaries for nutrients suffer hypoxia.

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

The 5 "P's" -- Pallor, paresthesias, pulseless, paralysis, and pain on passive extension of the compartment-- are useful in recognition in the latter stages of compartment syndrome. Pain is often reported early and almost universally. The description is usually of deep, constant, and poorly localized and is sometimes described as out of proportion with the injury. The pain is aggravated by stretching the muscle group within the compartment. Paresthesia (alterated sensation e.g "pins & needles") in the cutaneous nerves of the affected compartment is another typical sign. Paralysis of the limb are usually late findings. The compartment may feel very tense and firm as well (pressure). Note that a lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures.

If any of these occur, return to the Emergency Department immediately, or nearest Hospital.

Diagnosis

CCS can be tested for by gauging the pressure within the muscle compartments. If the pressure is sufficiently high, a fasciotomy may be required.

Treatment

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 ^[2]. Without treatment chronic compartment syndrome can develop into the acute syndrome ^[3]. A possible complication of surgical intervention for chronic compartment syndrome can be chronic venous insufficiency.

Complications

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.

See also

• Volkmann's contracture

References

1. ^ [1]
2. ^ Leversedge FJ, Casey PJ, Seiler 3rd JG, et al. Endoscopically assisted fasciotomy: description of technique and in vitro assessment of lower-leg compartment decompression. Am J Sports Med 2002;30(2):272-8.
3. ^ Mubarak SJ, Owen CA, Garfin S, et al. Acute exertional superficial posterior compartment syndrome. Am J Sports Med 1978;6(5):287-90.

External links

• Duke Orthopedics compartment_syndrome
• Merck Home 05-062a
• Fasciotomy, Chronic Venous Insufficiency, and the Calf Muscle Pump
• Compartment syndrome
• Saphenous nerve injury after fasciotomy for compartment syndrome
• American Association of Orthopaedic Surgeons Compartment Syndrome

•  • [ e] Consequences of external causes (, )
General external causes	Foreign body - Burn - Frostbite
Other external causes	Radiation poisoning - Hyperthermia - Hypothermia - Immersion foot - Chilblain - Aerosinusitis - Hypoxia - Barotrauma - Altitude sickness - Chronic mountain sickness - Decompression sickness - Asphyxia - Starvation - maltreatment (Physical abuse, Sexual abuse, Psychological abuse) - Motion sickness (Airsickness, Sea-sickness) - Electric shock - Angioedema - Hypersensitivity (Allergy)
Certain early complications of trauma	Air embolism - Fat embolism - Crush syndrome/Rhabdomyolysis - Compartment syndrome - Volkmann's contracture
Complications of surgical and medical care	Serum sickness - Malignant hyperthermia

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List of ICD-10 codes. The version for 2007 is available online at [1]

Chapter Blocks Title
I Certain infectious and parasitic diseases
II Neoplasms
III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
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For other uses of "ICD", see ICD (disambiguation).

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD
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The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.

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Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. Created and updated by the United States National Library of Medicine (NLM), it is used by the MEDLINE/PubMed
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fascial compartments, and are formed by tough connective tissue septa.

These compartments usually have a separate nerve and blood supply to their neighbours. The muscles in each compartment will often all be supplied by the same nerve.
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In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue.

Tests of adequate perfusion are a part of patient triage performed by medical or emergency personnel in a mass casualty incident.
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Seddon's classification is a scheme for describing nerve injury.

1. Neurapraxia -- pressure on the affected nerve with no loss of continuity.
2. Axonotmesis -- neural tube intact, but axons are disrupted. These nerves are likely to recover.

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MeSH D009135 In medicine, a myopathy is a neuromuscular disease in which the muscle fibers do not function for any one of many reasons, resulting in muscular weakness. "Myopathy" simply means muscle disease (myo- Greek μυσ "muscle" + -pathy Greek "suffering").
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Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue.) It is largely a category of exclusion rather than one with a precise definition, but all or most tissues in this category are similarly:
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Fasciotomy is a surgical procedure where the fascia is cut to relieve tension or pressure (resulting in loss of circulation to an area of tissue or muscle). Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome.
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Fasciotomy is a surgical procedure where the fascia is cut to relieve tension or pressure (resulting in loss of circulation to an area of tissue or muscle). Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome.
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MeSH D012206 Rhabdomyolysis is the rapid breakdown of skeletal muscle tissue due to traumatic injury, either mechanical, physical or chemical. The principal result is a large release of the CK enzymes and other cell byproducts into the blood system and acute renal failure
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MeSH C12.777.419.780.500 Renal failure or kidney failure is the condition in which the kidneys fail to function adequately.

Biochemically, it is typically detected by an elevated serum creatinine.
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MeSH C05.651.180 Volkmann's contracture, also known as Volkmann's ischaemic contracture, is a permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers.

History

It is named after Dr.
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Duke University is a private coeducational research university located in Durham, North Carolina, USA. Founded by Methodists and Quakers in the present-day town of Trinity in 1838, the school moved to Durham in 1892.^[9] In 1924, tobacco industrialist James B.
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Effects of foreign body entering through natural orifice
Classification & external resources

ICD-10 T 15. -T 19.
ICD-9 930 - 939

In physiology, a foreign body (Latin: corpus alienum) is any object originating outside the body.
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MeSH D002056 In medicine, a burn may be an injury caused by heat, cold, electricity, chemicals, friction or radiation (e.g. a sunburn).

Classification

• First-degree burns

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Frostbite
Classification & external resources

Hands, feet, noses, and ears are most likely to be affected by frostbite
ICD-10 T 33. -T 35.
ICD-9 991.0 - 991.
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Radiation poisoning, also called "radiation sickness", is a form of damage to organ tissue due to excessive exposure to ionizing radiation. The term is generally used to refer to acute problems caused by a large dosage of radiation in a short period.
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Heat stroke
Classification & external resources

ICD-10 T 67.0
ICD-9 992.0

DiseasesDB 5690
MedlinePlus 000056
eMedicine med/956   Heat exhaustion
Classification & external resources

ICD-10 T 67.3 - T 67.5
ICD-9 992.
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Hypothermia
Classification & external resources

ICD-10 T68
ICD-9 780.9 , 991.6

Hypothermia is a condition in which an organism's temperature drops below that required for normal metabolism and bodily functions.
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Immersion foot
Classification & external resources

ICD-10 T 69.0
ICD-9 991.4

DiseasesDB 31219

Immersion foot, archaically trench foot, is a medical condition caused by prolonged exposure of the feet to damp and cold.
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Chilblains, also called perniosis or blain, when occurring on the feet, is a medical condition that is often confused with frostbite and trench foot. Chilblains are acral ulcers that occur when a predisposed individual is exposed to cold and humidity.
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Barotrauma, sinus
Classification & external resources

ICD-10 T70.1
ICD-9 993.1

Aerosinusitis, also called barosinusitis, sinus squeeze or sinus barotrauma
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For other uses of the term "hypoxia", see hypoxia.

Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply.
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