Compartment Syndrome

The reason for compartment syndrome is the excessive build up of pressure in one of the tissue compartments of the limbs, stopping the arterial pressure from supplying the area and depriving the tissues of adequate blood supply. Death of the local tissues with significant pain can occur if treatment is not promptly administered. The forearm and the lower leg are the most common sites for this to occur, in which areas the muscles are bounded by a semi-rigid compartment made up of firm connective tissue fascia and by bone. If the pressure builds up inside here its lack of extensibility can cause problems within the compartment.

The largest cause of compartment syndrome is a tibial fracture, with other causes including other fractures, blood vessel compromise, crush injuries and tight plasters or dressings. Symptoms once compartment syndrome is established are a loss of the pulses, inability to move the part and loss of sensibility. If the doctor suspects that compartment syndrome is present then surgical decompression is the primary treatment. Complications can include muscle breakdown leading to renal failure and Volkmann contracture, an irreversible contracture of the forearm muscles.

Whilst most compartment syndrome is acute following some kind of event, careful measurements of the pressures within the compartments of the leg have shown chronic compartment syndrome to be a clinical entity in situations such as excessive exercise performance. As the tissue pressure increases in the muscular and fascial compartment it starts to compromise the blood flow into the compartment, damaging the muscles and nerves. In the acute type the onset is fast and leads quickly to muscle and nerve damage which is irreversible unless treated urgently.

Chronic compartment syndrome is not dissimilar from shin splints and occurs in athletes, often bilaterally and after a specific time of exercising. There are various criteria for this condition in different activities and the intra-compartmental pressure can now be measured to look for abnormalities. The highest incidence of compartment syndrome occurs in patients with open tibial fractures and much less commonly in closed tibial fractures. Compartment syndrome can also occur along with vascular injuries but decompression may be routinely performed at the time of vascular repair.

For compartment syndrome to occur there must be either external or internal reasons for a raised pressure in the segments of the limb. External forces can include over tight clothes or boots and tight dressings or plasters. Internal factors can be numerous and include tissue swelling due to crush injury, fractures or internal tissue bleeding and even overdoing weightlifting. The muscles and the nerves are starved of blood due to the excessive pressure, causing chemical changes due to muscle necrosis which attract greater amounts of water into the compartment, increasing the pressure again. Eventually arterial blood flow is completely obstructed.

The elevation of pressure in the leg compartments needs decompression to be performed quickly or with a delay of six or ten hours there will be widespread tissue and muscle death and significant nerve damage. When muscles suffer damage this results in the release of myoglobin into the bloodstream which can engender renal damage which can be fatal. During exercise there is a volume increase in the muscles, raising the compartment pressures during the chronic type of this condition, keeping the levels high between muscle action and compromising blood flow. Muscle cramps can then occur as they do not get enough blood.

Acute blood lack in a limb is typically diagnosed by the presence of pain, pins and needles, paleness of the limb, a lack of pulses and a cold limb. However these signs and symptoms are not reliable from a clinical point of view. Patients may present with extreme levels of pain seemingly out of proportion to the level of their injury, with an aching, deep pain and worse with muscle stretching. On looking at the limb it should be obvious if there has been significant trauma which could give a clue as to internal damage. Sensory nerves are more easily compromised and testing for sensory loss is useful.

Fasciotomy is the definitive surgical treatment for compartment syndrome, a cutting into the individual muscle compartments to allow the pressure to dissipate outwards and decompress the areas. The wounds may be left open for some days until the pressure subsides and the tissues recover.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in bradford visit his website.

categories: Back pain,injury management,sciatica,Piriformis Syndrome,pain management,sciatica,back injury,back pain relief,Frozen Shoulder,Alternative medicine,physiotherapists,physiotherapy,Health,physical fitness

Related Articles:

• Back Pain Can Be Avoided By Finding A Great Lumbar Support Pillow | AutoPilotIncome101.com