Post by Master Kim on Feb 20, 2015 23:05:32 GMT -5
Compartment syndrome is increased pressure within one of the body's compartments which contains muscles and nerves. Compartment syndrome most commonly occurs in compartments in the leg or arm. There are two main types of compartment syndrome: acute and chronic.
Acute compartment syndrome occurs after a traumatic injury such as a car crash. The trauma causes a severe high pressure in the compartment which results in insufficient blood supply to muscles and nerves. Acute compartment syndrome is a medical emergency that requires surgery to correct. If untreated, the lack of blood supply leads to permanent muscle and nerve damage and can result in the loss of function of the limb.
Chronic exertional compartment syndrome is an exercise-induced condition in which the pressure in the muscles increases to extreme levels during exercise. The pressure creates a decrease in blood flow to the affected area which leads to a deprivation of oxygen to the muscles. The symptoms are a sensation of extreme tightness in the affected muscles followed by a burning sensation if exercise is continued. Chronic exertional compartment syndrome usually occurs in athletes who participate in repetitive impact sports such as running.
Signs and symptoms
Acute compartment syndrome
Classically, there are 6 "Ps" associated with compartment syndrome – pain out of proportion to what is expected based on the physical exam findings, paresthesia, pallor, paralysis, pulselessness, and poikilothermia. The first signs of compartment syndrome are numbness, tingling and paresthesia. Loss of function and decreased pulses or pulselessness, however, are late signs. According to Shears paresthesia in the distribution of the nerves transversing the affected compartment has also been described as relatively early sign of compartment syndrome, and later is followed by anesthesia (Shears, 2006). The other three symptoms of compartment syndrome are palpable pulse, paresis and pallor. These symptoms are irreversible and consistent during compartment syndrome and they are part of the diagnosis (Shears, 2006).
- Pain is often reported early and almost universally. The description is usually of deep, constant, and poorly localized pain out of proportion with the findings on physical examination (often incorrectly described as pain out of proportion to the injury). The pain is aggravated by passively stretching the muscle group within the compartment or actively flexing it (though this finding is not specific to compartment syndrome alone) and is not relieved by analgesia up to and including morphine.
- Paresthesia (altered sensation e.g., "pins & needles") in the cutaneous nerves of the affected compartment is another typical sign.
- Paralysis of the limb is usually a late finding. The compartment may also feel very tense and firm (pressure). Some find that their feet and even legs fall asleep. This is because compartment syndrome prevents adequate blood flow to the rest of the leg.
- A lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures and pulse is only affected if the relevant artery is contained within the affected compartment.
- Tense and swollen shiny skin, sometimes with obvious bruising of the skin.
- Congestion of the digits with prolonged capillary refill time.
Chronic exertional compartment syndrome
The symptoms of chronic exertional compartment syndrome (CECS) are brought on by exercise and consist of a sensation of extreme tightness in the affected muscles followed by a painful burning sensation if exercise is continued. After exercise is ceased, the pressure in the compartment will decrease within a few minutes, relieving painful symptoms. Symptoms will occur at a certain threshold of exercise which varies from person to person but is rather consistent for a given individual and can range anywhere from 30 seconds of running to about 10–15 minutes of running. CECS most commonly occurs in the lower leg, with the anterior compartment being the most frequently affected compartment. Foot drop is a common symptom of CECS.
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