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Compartment SyndromeAka: Volkmann's Ischemic Contracture

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  1. See Also
    1. Exertional Compartment Syndrome
  2. Pathophysiology
    1. Extremity trauma increases interstitial tissue pressure
      1. Crush injury
      2. Fracture
      3. Prolonged extremity compression
      4. Blood flow Restored in previously ischemic limb
      5. Prolonged application of MAST trousers (PASG)
    2. Increased pressure occurs in fixed fascial compartment
      1. Thigh, Leg or foot
      2. Forearm (3 compartments)
        1. Volar (wrist flexors, Median Nerve and Ulnar Nerve)
        2. Dorsal (wrist extensors, finger extensors)
        3. Mobile wad (muscle bodies)
      3. Hand (10 compartments)
        1. Hypothenar compartment
        2. Thenar compartment
        3. Adductor pollicis compartment
        4. Four dorsal interossei compartments
        5. Three volar interossei compartments
    3. Tissue pressure rises above that of capillaries
    4. Blood flow distal to high tissue pressures is cut off
    5. Distal nerve and muscle become ischemic and necrose
  3. Symptoms
    1. Severe extremity pain out of proportion to injury
    2. Paresthesias or anesthesia to light touch
    3. Mnemonic: "6 Ps"
      1. Pain
      2. Pressure (pain on palpation)
      3. Paresthesia
      4. Paresis (late sign)
      5. Pallor (late sign)
      6. Pulseless (last sign to occur)
  4. Signs
    1. Pain worse with passively Stretching involved muscles
      1. Passive finger or toe range of motion
      2. Patient flexes injured extremity to reduce pain
    2. Decreased sensation of involved nerves
      1. Vibratory sensation lost first
    3. Tense extremity swelling
    4. Less reliable signs of compartment syndrome
      1. Distal pulses may be diminished
        1. Occlude collateral circulation when assessing
      2. Distal extremity pallor may be present
  5. Diagnosis
    1. See Intracompartmental Pressure Monitor
  6. Management
    1. Pressures consistent with compartment syndrome
      1. Tissue pressure 15 to 25 mmHg with symptoms
      2. Tissue pressure >25 mmHg without signs or symptoms
    2. Fasciotomy indications
      1. Tissue pressure exceeds 30-45 mmHg
      2. Tissue pressure within 20 mmHg of Diastolic BP
  7. Course
    1. Compartment syndrome develops hours after injury
  8. References
    1. (1993) ATLS Providers Manual, p. 234-5
    2. Geiderman in Marx (2002) Rosen's Emerg. Med, p. 478-80

Compartment syndromes (C0009492)

Definition (MSH)Conditions in which increased pressure within a limited space compromises the BLOOD CIRCULATION and function of tissue within that space. Some of the causes of increased pressure are TRAUMA, tight dressings, HEMORRHAGE, and exercise. Sequelae include nerve compression (NERVE COMPRESSION SYNDROMES); PARALYSIS; and ISCHEMIC CONTRACTURE.
ConceptsDisease or Syndrome (T047)
ICD9958.90
EnglishCompartment syndrome, Compartment Syndromes
Spanishsindrome compartimental
Parent ConceptsTraumatic compartment syndrome (C1719662), Myopathy (C0026848), Vascular Diseases (C0042373), Ischemia (C0022116), Musculoskeletal Diseases (C0026857), Injury of anatomical site (C1264235), Injury by causative force (C1302887)
SourcesICD9CM, LCH, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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