Assessment and diagnosis of acute limb compartment. Lower extremity compartment syndrome is a devastating complication if not rapidly diagnosed and properly managed. Compartment syndrome is a complex physiologic process with significant. The classic symptoms of compartment syndrome can be deceiving as they occur late. At least 20 publication records of articles and or books related to the field of experimental and clinical research and surgery in. Apart from the typical signs and symptoms, measurement of intracompartmental pressure can also be important for diagnosis. Acute compartment syndrome acs represents a limbthreatening condition. How to diagnose and treat chronic exertional compartment syndrome. Treatment of the etiology of compartment syndrome should also be kept in mind while planning the fasciotomy. The foot and buttock region of the leg also have a lower incidence of compartment syndrome. Compartment syndrome of the foot is most commonly seen following crush injuries, falls from heights, and motor vehicle accidents. Diagnosis and management of acute compartment syndrome in the. Compartment syndrome internal medicine clinical resource.
Foot compartment syndrome can also complicate up to 10% of calcaneus fractures. Acute compartment syndrome occurs when there is increased pressure. The clinical diagnosis is not reliable if done infrequently, in children, or in unconscious patients in whom pain cannot be assessed. Acute compartment syndrome of the extremities uptodate. It presents indepth coverage of acute and chronic compartment syndromes, considerations of interstitial space, intramuscular pressure recordings, and limb edema. Novel diagnosis and prevention strategies, as well as common misconceptions and legal ramifications stemming from compartment syndrome. A guide to diagnosis and management will be indispensable for orthopedic and trauma surgeons confronted with this common yet challenging. The clinical diagnosis of compartment syndrome of the lower leg. Compartment syndrome is diagnosed when the interstitial pressure inside a muscle compartment is elevated to a point that. The clinical diagnosis of compartment syndrome of the. Chronic exertional compartment syndrome is an exerciseinduced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. When compartment syndrome is suspected, circumferential dressings should be split and casts should be bivalved. Acute compartment syndrome is considered a surgical emergency that, if not treated immediately, can lead to devastating disabilities, amputation, or even death. Chronic exertional compartment syndrome of the leg.
In a study evaluating the utility of clinical findings in making the diagnosis of compartment syndrome, ulmer noted that the sensitivity and positive predictive value of clinical findings are low whereas the specificity and negative predictive value of these findings are high. Normal compartment pressure is compartment syndrome occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. Request pdf the clinical diagnosis of compartment syndrome of the lower. The incidence of compartment syndrome depends on the patient population studied and the etiology of the syndrome.
Novel modalities to diagnose and prevent compartment syndrome. Traditionally, we are all taught that compartment syndrome is a clinical diagnosis which is true and that it can be diagnosed by the presence of the 5 ps well, that may be part of the story. Listing a study does not mean it has been evaluated by the u. Compartment syndrome definition of compartment syndrome. This open access book describes the state of the art in the diagnosis and management of compartment syndrome, including novel prevention strategies. Clinical features and diagnosis of lower extremity peripheral artery disease. Compartment syndrome an overview sciencedirect topics. Does compartment syndrome of the foot really exist. The pathophysiology, diagnosis and current management of acute compartment syndrome.
Diagnosis is typically made by clinical examination and compartment pressure measurement. Compartment syndrome occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves. Delaying diagnosis and therapy may lead to irreversible neuromuscular ischemic damages with subsequent functional deficits. When the swelling decreases, the incision will be repaired. The current clinical diagnostic criteria are presented, as well as the multiple. In the event of a diagnosis of compartment syndrome when there is a intracompartment pressure of 30 mmhg, an urgent fasciotomy is recommended, raised icp threatens the viability of the limb and cs compartment syndrome represents a true medical emergency. Objective to assess whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings data sources a medline search of the english literature from 1966 to 2001 was performed using compartment syndromes as the subject.
The clinical presentation of peripheral arterial disease and guidance for early recognition. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to gain access to this resource from offcampus. The images or other third party material in this book are included in the books creative commons license, unless indicated otherwise in a credit line to the material. Chronic exertional compartment syndrome symptoms and. The rise in serum creatine kinase by itself was not diagnostic of postpartum compartment complication but when combined with clinical findings, the condition was recognized and treated. Any concern for compartment syndrome based on mechanism, or the presence of pain in the affected extremity, should prompt a compartment pressure check. Compartment syndrome pressure measurements and diagnosis. Compartment syndrome is a complex physiologic process with significant potential harm, and though an important clinical problem, the basic science and research surrounding this entity remains poorly. If the clinical diagnosis of compartment syndrome is made, emergent fasciotomy and decompression is indicated. What are the clinical signs and symptoms of compartment syndrome. The influence of anesthetic technique on the clinical. High bladder pressure, along with other signs means abdominal compartment syndrome is likely. Diagnosis is typically made by measuring intraabdominal. In the event of a diagnosis of compartment syndrome when there is a intra compartment pressure of 30 mmhg, an urgent fasciotomy is recommended, raised icp threatens the viability of the limb and cs compartment syndrome represents a true medical emergency.
The classic signs and symptoms of acute compartment syndrome are often listed as the 5 or 6 ps including some variation of pain, pressure, pulselessness, paralysis, paresthesia, and pallor 1, 2, 5, 9. Acute compartment syndrome is primarily a clinical diagnosis. Compartment syndrome is caused by an increased pressure within a closed. The diagnostic dilemma of acute compartment syndrome is always present because it is a clinical diagnosis. Compartment syndrome home foundation for orthopaedic. Following delivery, one of the patients developed sudden severe ankle pain which was consistent with and subsequently confirmed as acute compartment syndrome. Compartment syndrome is a painful condition caused by pressure in a group of muscles. It usually occurs in the legs, feet, arms or hands, but can occur wherever theres an enclosed compartment inside the body. Compartment syndrome due to patient positioning, in children and polytrauma patients, and unusual presentations are likewise covered. Compartment syndrome tintinallis emergency medicine. Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome. A marked increase in pain, swelling, and pain with. The most widely studied and understood form of compartment syndrome is traumarelated compartment syndrome, often referred to as acute compartment syndrome acs and can occur following fractures. Compartment syndromes of the hand are rare but occasionally the emergency physician will be afforded with the opportunity to make this diagnosis and avert significant morbidity for the patient.
The clinical entity of compartment syndrome in the 2 compartments of the forearm and 4 compartments of the leg is well accepted. Delay in diagnosis leads to paralysis, deformity, and appreciable. The clinical diagnosis of compartment syndrome of the lower. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. In a study by qvarfordt and colleagues, 14% of patients with leg pain were noted to have anterior compartment syndrome. Several commercial devices are available to measure compartment pressures.
Compartment syndrome a guide to diagnosis and management. Compartment syndrome is defined as a critical pressure increase within a confined compartmental space. Chronic exertional compartment syndrome of the leg in the military. Learn more about the types, causes, symptoms and treatment options.
Chronic exertional compartment syndrome cecs is a condition that typically affects young endurance athletes, especially those who run extensively. Compartment syndrome tintinallis emergency medicine manual. Compartment syndrome elevated tissue pressure within a closed fascial space reduces tissue perfusion ischemia results in cell death necrosis true orthopaedic emergencylimb compartment syndrome acute chronicabdominal compartment syndrome. Compartment syndrome pediatric orthopaedic society of. Compartment syndrome is a condition in which increased pressure within a muscle compartment containing nerves and vasculature, enclosed by unyielding fascia leads to impaired tissue perfusion. The pressure in a compartment only increases during that activity and goes down after the activity is stopped. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures.
The presentation may be acute, subacute or chronic. If material is not included in the books creative commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to. Diagnosis and treatment can be difficult and little consensus exists in the literature. Compartment syndrome cs refers to a collection of symptoms arising as a result of increased pressure in the muscle compartment that results in compromised tissue perfusion duckworth and mcqueen, 2011, foong et al. Sometimes the incision cannot be closed immediately, so a skin graft may be necessary. Thus, the need for decompression by removal of all dressing down to skin, followed by. This condition is usually less limiting and does not lead to loss of function or limb. Chronic exertional compartment syndrome cecs is commonly misdiagnosed and often patients go though an exhaustive trial of treatments that fail to alleviate their pain. References evidencebased clinical decision support at the.
Jun 06, 2009 chronic exertional compartment syndrome cecs is commonly misdiagnosed and often patients go though an exhaustive trial of treatments that fail to alleviate their pain. Compartment syndrome is increased tissue pressure within a closed fascial space, resulting in tissue ischemia. Compartment syndrome diagnosis and tests cleveland clinic. Like acute compartment syndrome acs, it is thought to result from increased pressure within a muscle compartment. Clinical features the signs and symptoms of acute compartment syndrome acs generally appear in a stepwise fashion, although the. Diagnosis of acs mostly relies on clinical findings. Other exerciserelated problems are more common than chronic exertional compartment syndrome, so your doctor may first try to rule out other causes such as shin splints or stress fractures before moving on to more specialized testing. This unique open access book fills the gap in the knowledge of compartment syndrome. The most common sites affected are in the leg, thigh, forearm, foot, hand and buttock in this article, we shall look at the pathophysiology, clinical features and management of acute compartment syndrome. This book is distributed under the terms of the creative commons.
Compartment syndrome is a painful condition that occurs when too much pressure is built up within and between muscles. Jun 07, 2014 compartment syndrome of the foot is most commonly seen following crush injuries, falls from heights, and motor vehicle accidents. The text includes the most current research and data on compartment syndromes. Acute compartment syndrome is a clinical diagnosis and needs prompt treatment. Jul 28, 2010 the use of near infrared spectroscopy in the diagnosis of acute compartment syndrome the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Diagnosis is assessed by invasive pressure monitoring within the suspected compartment. A high clinical suspicion is important to recognize an evolving compartment syndrome of the hand.
Due to the larger size of these compartments and their interconnectivity, they are less predisposed to elevated tissue pressures. This phenomenon is because the clinical signs and symptoms of acs are variable and nonspecific, and there are multiple causes of acs after trauma table 17. A doctor may suspect compartment syndrome based on the type of injury, a persons description of symptoms, and a physical exam. Chronic exertional compartment syndrome symptoms and causes. Although the diagnosis approach to leg compartment syndrome is clinical in priority, pressure measurements should be systematically produced. Apr 24, 2020 the impact of acute compartment syndrome on the outcome of tibia plateau fracture. The diagnosis of acs requires a high index of clinical suspicion in the appropriate clinical setting. The earliest symptom is pain out of proportion to the severity of injury. Acute compartment syndrome acs of an extremity following trauma is a diagnostic challenge. Novel diagnosis and prevention strategies, as well as common misconceptions and legal ramifications stemming from compartment syndrome, round out the presentation. Assessment and diagnosis of acute limb compartment syndrome. The pathophysiology, diagnosis and current management of.
A condition in which increased compartment pressure within a confined space, compromises the circulation and viability. Compartment syndrome management and treatment cleveland clinic. Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate management with fasciotomy while clinical evaluation is flawed, pain out of proportion to injury and pain with passive stretch of muscles within. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the. Chronic exertional compartment syndrome diagnosis and. The current clinical diagnostic criteria are presented, as well as the multiple dilemmas. Jan 18, 2019 the american academy of orthopaedic surgeons released a new clinical practice guideline to help physicians develop an evidencebased approach for the diagnosis and treatment of adult patients with. However, one can diagnose it accurately with a thorough history and following up on strong clinical suspicion. Schmidt background acute compartment syndrome acs of an extremity following trauma remains a diagnostic and therapeutic enigma.
If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. Aaos releases new clinical practice guideline on acute. Pulselessness and paralysis are rare, only occurring after an arterial injury or after a substantial amount of time has elapsed. The american academy of orthopaedic surgeons released a new clinical practice guideline to help physicians develop an evidencebased approach for the diagnosis and treatment of adult patients with. Pdf the pathophysiology, diagnosis and current management.
Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate management with fasciotomy while clinical evaluation is flawed, pain out of proportion to injury and pain with passive stretch of muscles within the compartment are the best screening tools. The diagnosis is largely clinical with the classical description of pain out of proportion to the injury. Longterm chronic compartment syndrome can be caused by repetitive activities, such as running. Home books tintinallis emergency medicine manual, 8e. However, the pain can limit activity and endurance. Compartment syndrome knowledge for medical students and. Surgery is required with a procedure called a fasciotomy, in which an incision is made into the skin and fascia that covers the affected compartment. Diagnosis is clinical and usually confirmed by measuring compartment pressure. The condition can be either acute or chronic and can cause nerve and muscle damage. Acute compartment syndrome statpearls ncbi bookshelf. Almost all orthopaedic surgeons come across acute compartment syndrome acs in their clinical practice.
There is a plethora of differential diagnoses for this syndrome. The differential diagnosis for compartment syndrome includes other causes of pain, such as fracture, hematoma, or infection. Laboratory and imaging tests can support the diagnosis. This diagnosis can be confirmed by measuring the pressure within the. How to diagnose and treat chronic exertional compartment. Anyone can develop the condition, but its more common in young adult runners and athletes who participate in activities that involve repetitive impact. A manual search of the bibliographies of retrieved articles and of major orthopaedic texts was also performed. Volkmanns ischemic contracture is most commonly due to neglected compartment syndrome.