Compartment Syndrome, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Compartment Syndrome, Diagnosis and Treatment and Related Diseases
Compartment syndrome is a serious medical disorder that causes higher pressure in a muscle compartment.
It can result in muscle and nerve damage and disorders with blood flow.
Compartment syndrome is produced by a higher pressure within a closed anatomical space, which involves the circulation and function of the tissues within that space.
This may lead to temporary or permanent injury to muscles and nerves.
Compartment syndrome can be acute or chronic:
Acute compartment syndrome is most often produced by trauma, which may be relatively minor.
Chronic compartment syndrome is normally produced by exercise and manifests with recurrent pain and disability, which stop when the cause is ceased but return when the activity is restarted.
Causes
Thick layers of tissue, called fascia, separate the groups of muscles in the arms and legs from each other.
Inside each sheet of fascia is a restricted space called a compartment.
The compartment affects the muscle tissue, nerves, and blood vessels.
Fascia encloses these structures, similar to the way in which insulation envelops wires.
Any swelling in a compartment will lead to higher pressure in that area.
This higher pressure compresses the muscles, blood vessels, and nerves.
If this pressure is increased too much, blood flow to the compartment will be obstructed.
This can cause permanent damage to the muscle and nerves.
If the pressure lasts long enough, the muscles may die and the arm or leg will not move.
Acute compartment syndrome may be caused by:

1. Trauma, such as a crush injury or surgery
2. Broken bone
3. Very bruised muscle
4. Severe sprain
5. A cast or bandage that is too tight
6. Fractures
7. Crush injury.
   Symptoms
8. Decreased sensation, numbness, tingling, weakness of the affected area
9. Paleness of skin
10. Serious pain that does not go away after taking pain medicine
11. Swelling or inability to move the affected part
    Acute compartment syndromes normally manifest within 48 hours of injury.
    Diagnosis
    Diagnosis is basically medical with identification of patients at danger and early signs.
    Intra-compartmental pressure is measured by several methods, such as needle manometry, infusion methods, wick catheter, pressure transducers or side-ported needles
    MRI scans help make the diagnosis of compartment syndrome in medically uncertain cases

Treatment
The purpose of treatment is to avoid permanent injury.
For acute compartment syndrome, surgery is required immediately.
Any delay in surgery can result in permanent injury.
The surgery is called fasciotomy and requires cutting the fascia and muscle to alleviate pressure.
All possibly constricting dressings, casts and splints must be taken off.
Splitting a plaster is not adequate.
The compartment pressure should be gauged.

Open fasciotomy:
Indications for fasciotomy differ between different doctors such as:

1. An absolute compartment pressure greater than 30-40 mm Hg with a medical picture consistent with compartment syndrome;
2. Difference between diastolic pressure and compartment pressure less than 30 mm Hg or
3. Difference between mean arterial pressure and compartment pressure less than 40 mm Hg.
   The skin and deep fascia must be opened out along the whole length of the compartment.
   All four compartments may require to be opened in cases affecting the leg.
   Following fasciotomy, the wound should be kept open.
   Recovery may be helped by suturing, skin grafting or the wound left to recover by itself.
   Debridement may be required for any muscle necrosis
   The affected area must be elevated above heart level to reduce s

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