Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
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.
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.
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.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Shin splints result from inflammation from injury to the tendon and adjacent tissues in the front of the outer leg. Shin splints commonly occur in runners or aggressive walkers, causing pain and discomfort. An increase in workout intensity, weak ankles and pronation may be to blame for shin splints. Stretching, strengthening, and icing the affected area are effective treatments for shin splints. Rest and anti-inflammatory medications are also advised.
Carpal tunnel syndrome is a condition in which irritation of the wrist's median nerve causes tingling and numbness of the thumb, index, and the middle fingers. This condition is known as tarsal tunnel syndrome in the ankles and feet. Treatment of carpal tunnel syndrome depends on the severity of the symptoms and the nature of any disease that might be causing the symptoms.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin. The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. Treatments include applying an ice pack and pressure to the area by hand.
Burns are categorized by severity as first, second, or third degree. First degree burns are similar to a painful sunburn. The damage is more severe with second degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the location, total burn area, and intensity of the burn.
There are several bones in the foot, and these bones can be broken (fractured) in a variety of ways. Falling from heights, dropping heavy objects on the foot, or stress fractures from running or walking. Treatment of a broken foot depends on what bone in the foot is broken.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Hemophilia is one of a group of inherited bleeding disorders. Hemophilia A and B are inherited in an X-linked recessive genetic pattern and is more common in males. Symptoms of hemophilia include bleeding into the joints, muscles, GI or urinary tract, or brain or skull. Treatments for hemophilia is generally replacement of blood clotting factors.
Pet vipers are a family of poisonous snakes, which includes rattlesnakes, copperheads, and water moccasins (cottonmouths). Treatment of poisonous snake bites is possible, however, any victim of a venomous snake bite should be evaluated in an emergency medical care facility as soon as possible.
Repetitive motion disorders (RMDs) are muscular conditions that result from repeated motions. Carpal tunnel syndrome, trigger finger, bursitis, and tendonitis are types of RMDs. Symptoms and signs include pain, swelling, numbness, tingling, and loss of strength and flexibility. Treatment involves stopping the activity that's causing symptoms, adopting stretching and relaxation exercises, icing the affected area, and using pain relievers.
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...
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