compartment syndrome

Question 1

what is compartment syndrome?

Answer 1

A rise in pressure within a compartment due loss of blood supply to the muscle and nerve within compartment

Question 2

cause

Answer 2

any injury leading to oedema
fracture
ischaemia to the compartment leading to muscle oedema

Question 3

eaton and green cycle for compartment syndrome?

Answer 3

trauma — muscle ischaemia —histamine release —increased capillary permeability— intramuscular oedema (venous occulsion)—increased intramuscular pressure—venous lymphatic obstruction—arterial ovculsion/spasm —muscle ischaemia

Question 4

diagnosis

Answer 4

excessive pain
not relieved with usual dose of analgesics
stretch test: passive moving the joint in direction opposite to that of the damage muscle action
tense compartment
hypothesia in the distribution of involved nerve
muscle weakness
pressure <30 mmhg
<20 mmhg indicate intercompartmental pressure is suggestive of compartment syndrome

Question 5

treatment

Answer 5

limb elevation
active finger movement
fasciotomy
fibulectomy

Question 6

pt mgt (lower extremity compartment syndrome)

Answer 6

Conservative therapy

• Conservative treatment of CECS mainly involves a decrease in activity or load to the affected compartment.
• Aquatic exercises, such as running in water, can maintain/improve mobility and strength without unnecessarily loading the affected compartment.
• Massage/ Massage therapy can also help by patients with mild symptoms or people who have declined surgical intervention, enabling them to engage in more exercise without pain
• stretching exercises

Pre-surgical therapy
•Pre-surgical therapy in CECS includes reduction of activity, with encouragement of cross-training and muscle stretching before initiating exercise.
•Other preoperative measures are rest, shoe modification, and the use of nonsteroidal anti-inflammatory medications (NSAIDs) to reduce inflammation.
•It is recommended to avoid casting, splinting, or compression of the affected limb.

Post-surgical therapy

• assisted weight bearing with some variation, depending on surgical technique.
• Early mobilisation is recommended as soon as possible to minimise scarring, which can lead to adhesions and a recurrence of the syndrome.

•Activity can be upgraded to stationary cycling and swimming after healing of the surgical wounds
•Isokinetic muscle strengthening exercises can begin at 3-4 weeks.
•Running is integrated into the activity program at 3-6 weeks
•Full activity is introduced at approximately 6-12 weeks, with a focus on speed and agility
•The following are recommendations for a full recovery and to avoid recurrence;
-Wearing more appropriate footwear to the terrain
-Choosing more appropriate surfaces and terrain for exercise
-Pacing your activities
-Avoiding certain activities altogether
-Mastering strategies for recovery and maintenance of good health (e.g, appropriate rest between sessions)
-Modifying the workplace to lower the risk of injury

•restore range of motion, mobility, strength and function.[

Question 7

What are the 5 P’s of compartment syndrome?

Answer 7

pain,
pallor (pale skin tone),
paresthesia (numbness feeling), pulselessness (faint pulse) and
paralysis (weakness with movements)

Question 8

why pressure increase in the compartment syndrome?

Answer 8

Because the fascia does not stretch, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment. Blood flow to muscle and nerve cells is disrupted.

Question 9

Compartment Syndrome

Lower Extremity

Answer 9

It is a condition in which increased pressure (usually due to fracture haematoma) within the osteo-musculo-facial space compromises the circulation of the contents of that space and thereby causes damage to the tissues in the compartment.
It mainly occurs in forearm and leg

Question 10

pathophysiology

Answer 10

normal tissue pressure
0-4 mmhg
8-10 with extension

absolute pressure theory
30 mmhg -mubarak
45 mmhg -masten

pressure gradient theory
<30 mmhg of diastolic pressure
-whitesides, mcqueen

Question 11

tissue survivals

Answer 11

muscle

3-4 hours - reversible changes
6 hours - variable damage
8 hours-irreversible change

nerve

2 hour-loose nerve conduction
4 hour-neuropraxia
8 hour- irreversible changes

Question 12

delayed diagnosis

Answer 12

contracture
infection
amputation
permanent sensory & motor deficit

Question 13

how we diagnose 6ps?

Answer 13

• pain out of proportion
• palpably tense compartment
• pain with passive stretch
• parasthesia
• paralysis
• pulselessness/ pallor

Question 14

tYpes

Answer 14

A - anterior tibial syndrome or compartment syndrome
B-lateral compartment syndrome (peroneal compartment syndrome)
C- posterior compartment syndrome
1-superficial posterior compartment syndrome
2-Deep posterior compartment syndrome