Compartment Syndrome

Question 1

The diagnosis ofcompartment syndromeis primarily a clinical one based on careful history and physical examination

Answer 1

T

Question 2

Compartment pressure greater than 50 mm Hg or within
is considered to be an indication of fasciotomy

Answer 2

F Compartment pressure greater than 30 mm Hg or within
20 to 30 mm Hg of the diastolic blood pressure is considered to be indication for fasciotomy

Question 3

Fasciotomy in a timely manner is the only management for
compartment syndrome with good outcome expected

Answer 3

T

Question 4

compartment syndrome can occur in any closed space in
the body,even the orbit

Answer 4

T

Question 5

mostly occurs within fibro-osseous space in the upper
and lower extremities

Answer 5

T

Question 6

most common site is the upper extremities

Answer 6

F most common site is the lower leg, followed by the forearm and hand.
Upper arm compartment syndrome
is rare, with few reported cases.

Question 7

91% of the patients were men in their thirties why?

Answer 7

being more likely to sustain high-energy injuries, the author suggested that less space for muscle swelling of the muscle after injury led to a higher incidence of acute compartment syndrome in young men

Question 8

The upper arm consists of two compartments around the
humerus: the anterior and posterior compartments . They are divided by the lateral and medial intermuscular septae

Answer 8

T

Question 9

The musculocutaneous nerve and median nerves run through the posterior compartment

Answer 9

F The musculocutaneous nerve and median nerves run through the anterior compartment

Question 10

why symptoms of radial or ulnar nerve ischemia are
not compartment specific?

Answer 10

F The ulnar and radial nerves travel in one compartment first, and then pass through the intermuscular septum into
another compartment at the level ofdistal third ofthe arm

Question 11

The muscles in the volar compartments are
usually divided into superficial and deep groups

Answer 11

T

Question 12

The forearm has three major compartments, and the radius, ulna,
and rigid interosseous membrane constitute the stifffloor ofthe compartments

Answer 12

T

Question 13

The deep volar muscles are usually the most severely affected in forearm compartment syndrome,

Answer 13

T

Question 14

The median nerve runs between the superficial
and deep muscles and ends at the carpal tunnel

Answer 14

T

Question 15

The ulnar nerve
is the most commonly affected nerve in forearm compartment syndrome.

Answer 15

F The median nerve
is the most commonly affected nerve in forearm compartment syndrome.

Question 16

The lateral compartment of the forearm include»»>

Answer 16

Brachioradialis muscle
Radial artery
Extensor carpi radialis muscles (ECRP,ECRL)

Question 17

The AIN and the deepest portion ofthe flexor muscles are severely damaged when compartment syndrome involves the
deep volar compartment

Answer 17

T

Question 18

The dorsal compartment contains the wrist and finger extensors,
and the motor branch of the radial nerve (posterior interosseous
nerve)

Answer 18

T

Question 19

Course of PIN

Answer 19

ravels obliquely through and into the supinator muscle. then lies in a plane between
the superficial and deep extensor muscles. In the distal forearm, the
PIN lies on the interosseous membrane

Question 20

The dorsal and lateral forearm compartments along with volar forearm compartment are usually effected together

Answer 20

F also
may develop isolated compartment syndrome

Question 21

There are at least 10 compartments in the hand divided into five groups: thenar, hypothenar, adductor pollicis, palmar, and dorsal interosseous

Answer 21

T

Question 22

The thenar, hypothenar, adductor pollicis, and
interosseous compartments contain 5 intrinsic muscles of hand

Answer 22

F The thenar, hypothenar, adductor pollicis, and
interosseous compartments contain 14 intrinsic muscles of hand

Question 23

compartment syndrome can still occur in the finger.

Answer 23

T Although the finger has no muscle, compartment syndrome can still occur in the finger.

Question 24

The compartments of the finger are considered to
be bounded by skin, and Cleland and Grayson ligaments

Answer 24

T

Question 25

Inadequate tissue perfusion within the compartment is the foundation, and progressive cell death is the final result of compartment syndrome

Answer 25

T

Question 26

The leak ofthe cellular membrane, especially the endothelium of a capillary results in increased capillary permeability, causing the intravascular fluid to move into the interstitial space

Answer 26

T

Question 27

Skeletal muscle can tolerate up to 4 hours of ischemia, and can recover partially after 6 hours, but incurs permanent damage after 8 hours

Answer 27

T

Question 28

Nerve conduction function is affected after 5 hour of ischemia

Answer 28

F Nerve conduction function is affected after 1 hour of ischemia

Question 29

peripheral nerves may undergo irreversible damage after 4 to 6 hours ofischemia

Answer 29

T

Question 30

Volkmann ischemic contracture is used to term the final result of tissue ischemia following compartment syndrome,

Answer 30

T

Question 31

What is the crush syndrome?

Answer 31

severe local compartment syndrome can also arise the systemic manifestations, which is called crush syndrome. Rapid return of toxic muscle products into the circulatory system may lead to renal failure, cardiac failure, respiratory failure, and intravascular coagulation

Question 32

prolonged limb positioning, can lead to compartment syndrom

Answer 32

T

Question 33

High pressure injection injury, drugs or contrast medium extravasation can lead to compartment syndrom

Answer 33

T

Question 34

Infections Tenosynovitis of the finger can lead to compartment syndrom

Answer 34

T

Question 35

Muscle overuse can lead to compartment syndrom

Answer 35

T

Question 36

most common cause for compartment syndrome in the extremities

Answer 36

Fractures are the most common cause for compartment syndrome in the extremities

Question 37

Open fractures do not necessarily prevent compartment syndrome why?

Answer 37

because the wounds may not open the compartment completely

Question 38

patients with open fractures had a higher incidence of fasciotomy than those with closed fractures

Answer 38

T

Question 39

Radius and/or ulna fractures were the most common cause of forearm compartment syndrome, followed by supracondylar fractures.

Answer 39

T

Question 40

Hand compartment syndrome can be caused by multiple metacarpal fractures

Answer 40

T

Question 41

Vascular injury with subsequent reperfusion injury is another common cause of compartment syndrome

Answer 41

T

Question 42

Continuous bleeding leads to ischemai that lead to oedema A delay in revascularization can aggravate ischemic edema that expands the compartment contents.

Answer 42

T

Question 43

ischemic condition after intramuscular perforator harvest may decrease pressure tolerance of the compartmental tissue.

Answer 43

T

Question 44

Rarer etiologies of compartment syndrome include muscle overuse, rhabdomyolysis, and systemic sclerosis.

Answer 44

T

Question 45

Crotalid envenomation, infection, electrical injuries, and burns have also been considered to cause a cascade of events that leads to the rapid formation of vascular permeability and interstitial edema

Answer 45

T

Question 46

The diagnosis of compartment syndrome is primarily clinical, and based on patient history, symptoms, and signs

Answer 46

t

Question 47

patient's history may be the only basis of the diagnosis and fasciotomy

Answer 47

T

Question 48

The fingers are often placed in extension position in a forearm compartment syndrome

Answer 48

F The fingers are often placed in flexion position in a forearm compartment syndrome

Question 49

in the intrinsic minus position in a hand compartment syndrome

Answer 49

T

Question 50

Swelling is usually not presented in all cases

Answer 50

F in all the patients

Question 51

Pain Early and sensitive finding

Answer 51

T Worse as passive stretching ofthe compartmental muscles

Question 52

Paresthesia Early sign Very low sensitivity but high specificity

Answer 52

T

Question 53

Paralysis Often indicates the compartment syndrome in an irreversible stage

Answer 53

T

Question 54

Pallor and Pulselessness Late symptom always present

Answer 54

F May not presented in a compartment syndrome

Question 55

All five Ps are more commonly seen in a primary vascular injury rather than compartment syndrome

Answer 55

T

Question 56

Pain is the early and sensitive finding before onset of ischemia

Answer 56

T

Question 57

passive palmar abduction of the thumb, thus stretching the abductor pollicis brevis, is associated with a thenar compartment syndrome.

Answer 57

T

Question 58

Paresthesia is another early sign, especially when a sensory nerve travels in the affected compartment.

Answer 58

T

Question 59

Paralysis= the final stage

Answer 59

T

Question 60

Doppler ultrasound and radiography imaging have been used for diagnosis of compart-ment syndrome.

Answer 60

F Doppler ultrasound and radiography imaging have been used to evaluate the primary injury and identify the amount of tissue edema, but not helpful for diagnosis of compart-ment syndrome.

Question 61

Chronic compartment syndrome commonly happen in the upper limp

Answer 61

characterized by exercise-induced and rest-relieved pain, and it rarely happens in the upper limbs

Question 62

Neurological symptoms such as tingling and hand numbness are not present in chronic compartment

Answer 62

F Neurological symptoms such as tingling and hand numbness were found in some cases

Question 63

differential diagnoses of chronic compartment

Answer 63

Negative findings of physical examination at rest can rule out other differential diagnoses including nerve compression syndrome, vascular claudication, and fascia! herniation

Question 64

Dynamic compartment pressure measurement is helpful to diagnose chronic compartment syndrome of the forearm.

Answer 64

T

Question 65

compartment syndrome is suspected, any external pressure including cast, bandage, or sutures should be immediately removed. The limb should be elevated at the level of the heart but not above this level

Answer 65

T

Question 66

When compart-ment syndrome is diagnosed, emergency fasciotomy is the only management with good expected outcomes.

Answer 66

T

Question 67

subcutaneous and endoscopic-assisted fasciotomies have been reported

Answer 67

T

Question 68

Fasciotomy procedures include only dividing the skin and fascia to release the compartmental muscles and nerves

Answer 68

F also identifying and excising of nonviable muscles.

Question 69

Upper arm fasciotomy is often performed via a medial incision and a lateral incision

Answer 69

T

Question 70

carpal tunnel decompression is often performed with forearm or hand fasciotomy

Answer 70

T

Question 71

Exp;oration between the flexor carpi ulnaris and flexor digitorum superficialis to decompress the median nerve and deep group of flexor muscles.

Answer 71

T

Question 72

Site in releasing the dorsal compartment

Answer 72

For dorsal forearm compartment syndrome, a longitudinal incision is designed on the line between the distal radioulnar joint and the lateral epicondyle

Question 73

incision is limited to the middle half of the forearm

Answer 73

T

Question 74

The fascia is then divided and approached between the extensor digitorum communis and extensor carpi radialis brevis

Answer 74

T

Question 75

The mobile wad can be released via the same incision by mobilization of the incision site

Answer 75

T

Question 76

Two longitudinal incisions are recommended by the authors to release the forearm compartment

Answer 76

One is along the ulnar edge of the radius over the flexor muscles, and the other is along the ulnar edge of the ulna over the extensor muscles

Question 77

All compartments in the hand, necessary to approach

Answer 77

f Although there are more than 10 compartments in the hand, it is unnecessary to approach all· the compartments

Question 78

Except carpal tunnel release, hand compartments are usually released by four incisions

Answer 78

T

Question 79

Finger decompression is performed with a midaxial lateral incision along the noncontact side of the finger to release the Cleland and Grayson ligaments

Answer 79

T

Question 80

The dissection is carried out superficial to the flexor sheath

Answer 80

T

Question 81

After fasciotomy, all the incisions are left open to avoid recompression of the compartments

Answer 81

F EXCEPT the incision for carpal tunnel release is closed directly.

Question 82

vacuum-assisted closure benefit

Answer 82

reduce the relative complications including wound edge necrosis, infection, and neurologic deficit

Question 83

Delayed primary closure or skin grafting to the open area is performed depending on the wound tension,

Answer 83

T

Question 84

Neurological deficit is the most common complication of the forearm compartment syndrome.

Answer 84

T