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February 10, 2012

Compartment Syndrome

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Compartment Syndrome Treatment

What Is the Treatment for Compartment Syndrome?

Chronic or exercise induced compartment syndrome rarely requires treatment. For some individuals find that over time the chronic compartment syndrome limits their favorite activities (for example, tennis, running, cycling). In cases such as this surgery is required.

Surgery (fasciotomy)

The treatment for acute compartment syndrome is surgery (fasciotomy). The surgeon (either an orthopedic or general surgeon) will perform a fasciotomy, an operation where the thick, fibrous bands that line the muscles are filleted open, allowing the muscles to swell and relieve the pressure within the compartment (similar to splitting open the casing of a sausage). Depending upon the amount of swelling (edema), a second operation may be required later to close the skin after the swelling has resolved.

Once acute compartment syndrome has occurred, there is no non-surgical alternative. Hyperbaric oxygen may be considered as an adjunct treatment after surgery to promote healing.

Treatment will also be directed to the underlying cause of the compartment syndrome and to try to prevent other associated complications including kidney failure due to rhabdomyolysis.

Read more in-depth information on the treatment of compartment syndrome »

What is compartment syndrome?

Compartment syndrome is a condition that occurs when injury causes generalized painful swelling and increased pressure within a compartment to the point that blood cannot supply the muscles and nerves with oxygen and nutrients. Muscles in the forearm, lower leg and other body areas are separated by fibrous bands of tissues into compartments, and this fibrous tissue is very inflexible and cannot stretch to accommodate the generalized swelling. If left untreated, muscles and nerves fail and may eventually die. As the compartment syndrome progresses, the structures controlled by the muscles and nerves inside the compartment may fail to function.

While most often occurring in the forearm and lower leg, compartment syndrome can rarely occur in other parts of the body that have muscles contained in compartments, including the hands and feet.

Compartment syndrome may be acute due to swelling that arises from injury, or it may be chronic because of exertion usually from athletic exertion.

What causes compartment syndrome?

Muscles are contained in compartments or thick fibrous bands of tissue or fascia. Because of injury, pressure can increase within the compartment to swelling (fluid accumulation) or bleeding. In non-contracting muscle, the compartment pressure is normally about 0-15 mmHg of pressure. If the pressure within the compartment increases (usually greater than about 30 -45mmHg; other clinicians use other pressure values that are within 30 mm of the diastolic blood pressure) most individuals develop compartment syndrome. When these high compartment pressures are present, blood cannot circulate to the muscles and nerves to supply them with oxygen and nutrients. Compartment syndrome symptoms such as pain and swelling will occur.

As the muscle cells lose their blood and oxygen supply, they use anaerobic metabolism and begin to die. If the condition is not recognized and treated, the whole muscle can die, scar down, and contract. Similarly, nerve cells that are damaged may fail causing numbness and weakness in the structures beyond the injury site. If infection or necrosis develops, the individual may need the limb amputated to prevent death.

Picture of Compartment Syndrome

What are the risk factors for compartment syndrome?

Acute compartment syndrome occurs as a complication of an injury. Often it is due to a fracture of the radius or ulna in the forearm or the tibia and fibula in the lower leg that causes significant bleeding in one or more of the compartments. Bleeding can also be due to a badly bruised muscle. Crush injuries may cause both bleeding and swelling of a muscle.

Some injuries can be more subtle. If a person is incapacitated and immobile for a prolonged period of time, for example, due to alcohol or drug intoxication, swelling or muscle damage may occur because a blood vessel was compressed. The weight of an object (or the weight of the body itself) compressing a muscle group can cause rhabdomyolysis (muscle breakdown).

Compartment swelling may occur if blood supply is re-established (reperfusion swelling) to an area that has lost it for a period of time. Two examples are: 1) a person is in an auto accident and their legs are trapped and compressed with heavy debris, and are subsequently freed from the debris after a period of time; 2) when a blood vessel is damaged and subsequently repaired through surgery.

Compartment syndrome may be a complication of bandages or casts that are applied too tightly, or due to swelling that occurs because the individual did not elevate the limb that was casted.

Other abrupt causes of compartment syndrome include burns, snake and other envenomation, and anabolic steroid use. Individuals taking anticoagulants have a higher risk for compartment syndrome after trauma. Because there is some controversy about when fasciotomy is required (especially with snake bites) consultation with a surgeon emergently is recommended by most experts.

Chronic compartment syndrome occurs because of excessive exercise, where repetitive motion and muscle use cause localized swelling and irritation. Most often, symptoms in the legs are seen with runners and bicyclists and in the arms of swimmers. Symptoms resolve with rest and very rarely progress to an acute limb threatening situation.




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Compartment Syndrome

What is hemophilia?

Hemophilia is not one disease but rather one of a group of inherited bleeding disorders that cause abnormal or exaggerated bleeding and poor blood clotting. The term is most commonly used to refer to two specific conditions known as hemophilia A and hemophilia B, which will be the main subjects of this article. Hemophilia A and B are distinguished by the specific gene that is mutated (altered to become defective) and codes for a defective clotting factor (protein) in each disease. Rarely, hemophilia C is encountered, but its effect on clotting is far less pronounced than A or B.

Hemophilia A and B are inherited in an X-linked recessive genetic pattern and are therefore much more common in males. This pattern of inheritance means that a given gene on the X chromosome expresses itself only when there is no normal gene present. For example, a boy has only one X chromosome, so a boy with hemophilia has the defective gene on his...

Read the Hemophilia article »




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