Compartment Syndrome: Causes, Diagnosis and Treatment
Compartment Syndrome is a condition in which the blood flow in a closed compartment is reduced or blocked by a increase in the pressure within the compartment which may cause death of tissues (muscles, nerves, skin etc) in that compartment.
To understand this definition clearly it is necessary to know what a Closed Compartment
The muscles within our body are enclosed by fascia (tough sheet like tissue). This fascia divides the muscles into separate segments. A group of muscles along with its fascia forms a closed compartment.
For example, the muscles of the leg that bring the foot upwards (dorsiflexion) form a separate compartment along with their nerve and blood supply called the anterior compartment.
As the compartment has a limited volume hence it cannot accommodate swelling after a certain degree. Swelling causes a increase in pressure within the compartment. When this rise in pressure increases beyond a certain degree then the blood supply of the compartment is blocked. This can cause death of tissues within the compartment.
Death of muscles and nerves can cause permanent disability. Dead muscle is absorbed by the body and replaced with fibrous tissue. Fibrous tissue contracts and pulls the hand or foot into a deformed position.
Different conditions in which compartment syndrome can occur include
- external pressure (as a limb pressed beneath a rock)
- tight bandages applied on the limb
- excessive exercise
- snake bite
- injection of drugs in the artery
- hemophilia (excessive bleeding within the compartment)
- nephrotic syndrome
This syndrome is most common
in the forearm flexor muscles (muscles that close the fist). Volkmann contracture is its sequel, in which the muscles are replaced by fibrous tissue, this causes the wrist and fingers to become permanently flexed.
have been classically described as 5 P's.
- Pain (Continuous and deep in the whole compartment. Passive finger movement increases the pain)
- Pallor (decreased blood supply results in a pale limb)
- Pulselessness (pulse may be absent or feeble)
- Paresthesia (abnormal sensation such as prickling or burning)
- Paralysis (indicates that nerves are not getting adequate blood hence not functioning properly)
The above symptoms are simply a guide to the diagnosis of compartment syndrome. All of them may not be present. If pulselessness and paralysis are present then it indicates that tissue death has occurred.
can be confirmed by measuring the compartment pressure. A simple pressure measuring device can be assembled with the help of the following equipment
- mercury manometer
- IV tubing
- 20ml syringe
- sterile saline bag
- 18 gauge needles
If the pressure is within the compartment reaches within 30mm
of the diastolic pressure (normal diastolic pressure is between 60 to 90mm of mercury) then compartment syndrome is present.
includes the following measures
- removal of all constrictive dressings and bandages
- elevation of the extremity (gravity aids in venous and lymphatic return)
- Fasciotomy. This is a surgical procedure in which the fascia of the involved compartment is slit open relieving the pressure.
Frequently Asked Questions
When can somebody have compartment syndrome and can I diagnose it at home?
Any person having the above mentioned conditions can have it. It is difficult to diagnose at home but you can suspect it if
- there is extreme swelling in the limb
- when you hold and move his fingers he has excruciating pain.
What measures can be taken in the emergency setting?
If you are a layman then
- remove all constrictive clothing
- make the patient lie down and elevate the limb so gravity can increase the return of fluid.
If you are a paramedic and have some basic knowledge of anatomy, then apart from the above mentioned measures, you can give a incision in the skin and superficial fascia over the site of maximum swelling. This will relieve the pressure, but should only be done if you are more than four hours away from a hospital.
When can I expect complete recovery?
If at the time of fasciotomy the operating surgeon finds no dead tissue, then you can expect full recovery, otherwise the degree of recovery will depend on the amount of dead tissue present. Full recovery can take 1 to 2 months.
Can surgery be avoided?
Once the syndrome has developed surgery is the only cure. Even if the diagnosis is doubtful, surgery is a better alternative than to risk muscle and nerve death.
I hope the above information was helpful. If you still have any query then you can ask it at the contact me page.
This page was last updated on 6th February 2009.
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