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Compartment Syndrome

Aka: Compartment Syndrome, Volkmann's Ischemic Contracture
  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 or Paresthesias 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. Specific extremity neurologic function
      1. Motor Exam
        1. Ulnar Nerve: Claw Hand
        2. Radial Nerve: Wrist drop
        3. Median Nerve: Cannot make OK Sign
        4. Peroneal Nerve: Foot drop
          1. Consider Anterior Tibial Compartment Syndrome
      2. Sensory Exam
        1. Radial Nerve: thumb web space
        2. Median Nerve: distal index
        3. Ulnar Nerve: distal pinky
  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.
Concepts Disease or Syndrome (T047)
MSH D003161
ICD9 958.90
ICD10 T79.A0
SnomedCT 111245009, 212379008, 45781009
English Compartment Syndromes, Syndromes, Compartment, Compartment Syndrome, Syndrome, Compartment, Compartment syndrome, NOS, Compartmental syndrome, NOS, Compartment syndrome, unspecified, compartment syndrome, compartment syndrome (diagnosis), COMPARTMENT SYNDROME, Compartment syndrome NOS, Compartment Syndromes [Disease/Finding], compartment syndromes, compartmental syndromes, compartmental syndrome, Compartment syndrome, Compartment syndrome (disorder), Compartment syndromes, compartment; syndrome, syndrome; compartment
Italian Sindrome compartimentale, Sindromi da compressione
Japanese コンパートメント症候群, ｺﾝﾊﾟｰﾄﾒﾝﾄｼｮｳｺｳｸﾞﾝ
Swedish Kompartmentsyndrom
Czech syndromy kompartmentu, syndromy lože, Kompartment syndrom, kompartment syndrom
Spanish Compartment syndrome, Sindromes de Compartimento, Sindromes de Compartimiento, Síndromes de Compartimento, Síndromes de Compartimiento, síndrome compartimental (trastorno), síndrome compartimental, Síndrome compartimental, Síndromes Compartimentales, Sindromes Compartimentales
Finnish Aitio-oireyhtymät
French Syndromes compartimentaux, Syndrome des loges, Syndrome de compression des loges musculaires, Syndrome de compression des loges, Syndromes des loges musculaires, Syndrome compartimental
Russian SDAVLENIIA SINDROMY, FOL'KMANNA ISHEMICHESKAIA KONTRAKTURA, KOMPARTMENT-SINDROM, КОМПАРТМЕНТ-СИНДРОМ, СДАВЛЕНИЯ СИНДРОМЫ, ФОЛЬКМАННА ИШЕМИЧЕСКАЯ КОНТРАКТУРА
Croatian SINDROMI MIŠIĆNIH ODJELJAKA
Polish Zespoły loży mięśniowych, Przykurcz Volkmanna, Zespoły uciskowo-niedokrwienne
Hungarian Compartment syndroma
Dutch spierloge; syndroom, syndroom; spierloge, compartimentsyndroom, Compartimentsyndromen, Compartimentsyndroom, Contractuur van Volkmann, Syndromen, compartiment-, Syndroom, compartiment-
Portuguese Síndrome de loca muscular, Síndromes de Compartimento
German Kompartmentsyndrom, Kompartmentsyndrome
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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