Compartment syndrome

Compartment syndrome
A forearm following emergency surgery for acute compartment syndrome
SpecialtyOrthopedics
SymptomsPain, numbness, pallor, decreased ability to move the affected limb[1]
ComplicationsAcute: Volkmann's contracture[2]
TypesAcute, chronic[1]
Causes
Diagnostic methodBased on symptoms, compartment pressure[5][1]
Differential diagnosisCellulitis, tendonitis, deep vein thrombosis, venous insufficiency[3]
Treatment

Compartment syndrome is a serious medical condition in which increased pressure within a body compartment compromises blood flow and tissue function, potentially leading to permanent damage if not promptly treated.[5][6][7] There are two types: acute and chronic.[8] Acute compartment syndrome can lead to a loss of the affected limb due to tissue death.[6][9]

Symptoms of acute compartment syndrome (ACS) include severe pain, decreased blood flow, decreased movement, numbness, and a pale limb.[5] It is most often due to physical trauma, like a bone fracture (up to 75% of cases) or a crush injury.[3][6] It can also occur after blood flow returns following a period of poor circulation.[4] Diagnosis is clinical, based on symptoms, not a specific test.[5] However, it may be supported by measuring the pressure inside the compartment.[5] It is classically described by pain out of proportion to the injury, or pain with passive stretching of the muscles.[5] Normal compartment pressure should be 12–18 mmHg; higher is abnormal and needs treatment.[9] Treatment is urgent surgery to open the compartment.[5] If not treated within six hours, it can cause permanent muscle or nerve damage.[5][10]

Chronic compartment syndrome (CCS), or chronic exertional compartment syndrome, causes pain with exercise.[1] The pain fades after activity stops.[11] Other symptoms may include numbness.[1] Symptoms usually resolve with rest.[1] Running and biking commonly trigger CCS.[1] This condition generally does not cause permanent damage.[1] Similar conditions include stress fractures and tendinitis.[1] Treatment may include physical therapy or, if that fails, surgery.[1]

ACS occurs in about 1–10% of those with a tibial shaft fracture.[6] It is more common in males and those under 35, due to trauma.[3][12] German surgeon Richard von Volkmann first described compartment syndrome in 1881.[5] Delayed treatment can cause pain, nerve damage, cosmetic changes, and Volkmann's contracture.[2]

  1. ^ a b c d e f g h i j k l Buerba RA, Fretes NF, Devana SK, Beck JJ (May 2019). "Chronic exertional compartment syndrome: current management strategies". Open Access Journal of Sports Medicine. 10: 71–79. doi:10.2147/oajsm.s168368. PMC 6537460. PMID 31213933.
  2. ^ a b El-Darouti MA (2013). Challenging Cases in Dermatology. Springer Science & Business Media. p. 145. ISBN 978-1-4471-4249-2. Archived from the original on 2017-07-29.
  3. ^ a b c d Ferri FF (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 317. ISBN 978-0-323-52957-0. Archived from the original on 2017-07-29.
  4. ^ a b Schmidt AH (July 2016). "Acute Compartment Syndrome". The Orthopedic Clinics of North America. 47 (3): 517–525. doi:10.1016/j.ocl.2016.02.001. PMID 27241376.
  5. ^ a b c d e f g h i j Donaldson J, Haddad B, Khan WS (2014). "The pathophysiology, diagnosis and current management of acute compartment syndrome". The Open Orthopaedics Journal. 8: 185–193. doi:10.2174/1874325001408010185. PMC 4110398. PMID 25067973.
  6. ^ a b c d Torlincasi AM, Lopez RA, Waseem M (2020). "Acute Compartment Syndrome". StatPearls. StatPearls Publishing. PMID 28846257. Retrieved 2020-01-15.
  7. ^ Peitzman AB, Rhodes M, Schwab CW (2008). The Trauma Manual: Trauma and Acute Care Surgery. Lippincott Williams & Wilkins. p. 349. ISBN 978-0-7817-6275-5. Archived from the original on 2017-07-29.
  8. ^ "Compartment Syndrome – National Library of Medicine". PubMed Health. Archived from the original on 10 September 2017. Retrieved 25 July 2017.
  9. ^ a b McQueen MM, Duckworth AD (October 2014). "The diagnosis of acute compartment syndrome: a review". European Journal of Trauma and Emergency Surgery. 40 (5): 521–528. doi:10.1007/s00068-014-0414-7. PMID 26814506. S2CID 38330727.
  10. ^ Cone J, Inaba K (2017-09-14). "Lower extremity compartment syndrome". Trauma Surgery & Acute Care Open. 2 (1): e000094. doi:10.1136/tsaco-2017-000094. PMC 5877908. PMID 29766095.
  11. ^ Blackman PG (March 2000). "A review of chronic exertional compartment syndrome in the lower leg". Medicine and Science in Sports and Exercise. 32 (3 Suppl): S4-10. doi:10.1249/00005768-200003001-00002. PMID 10730989.
  12. ^ Garner MR, Taylor SA, Gausden E, Lyden JP (July 2014). "Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century". HSS Journal. 10 (2): 143–152. doi:10.1007/s11420-014-9386-8. PMC 4071472. PMID 25050098.
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