Compartment Syndrome Lecture Powerpoint Flashcards
Complex regional pain syndrome
Painful conditions characterized by continuing regional pain disproportionate in time or degree to the usual course of any known trauma or other lesion, regional, non specific to nerve territory or dermatome and has distal prominance, 2 subtypes, most commonly occurs in postmenopausal women, unknown etiology only sometimes has inciting event
CRPS (Complex regional pain syndrome) type I vs II
- More common, without an identifiable nerve lesion
- less common, associated with a nerve lesion and obvious nerve injury and follows specific nerve group**, causalgia, involves peripheral, central, and autonomic nervous systems
5 Characteristics of CRPS (Complex regional pain syndrome)**
- Pain (burning or aching out of proportion to stimulus)
- Sensory hyperesthesia* (amplified reaction to normal pain stimulus) and allodynia* (painful response to normally harmless/nonpainful stimulus)
- Vasomotor (cyanosis, asymmetric skin temp)
- Sudomotor/edema (red skin or hyperhydrosis)
- Motor/trophic (changes in hair/nail growth, ulcerations, decreased ROM)
Diagnostic criteria for Complex regional pain syndrome (4)
- Clinical
- continuing pain disproportionate to inciting event
- displays at least one of the 5 characteristics
- no other diagnosis better explains
Complex regional pain syndrome (CRPS) stages
1 - acute, hours to days, sees burning aching pain, hyperalgesia and allodynia
II - Dystrophic, 3-6 months sees pain radiate distally, edema, cyanosis, hyperhydrosis
III - atrophic, >6 month, pain on any movement, ulcers, bone loss
Imaging considerations in Complex regional pain syndrome (CRPS) (3)
- Bone scinitigraphy (bone scan) can support diagnosis but not rule out
- radiograph can demonstrate osteoperosis but sensitivity is low
- autonomic testing
Complex regional pain syndrome (CRPS) treatment options (4)
- PT and OT 1st line***
- psychosocial and behavioral therapy
- interventional pain management such as nerve blocks
- NSAIDs, gabapentin, bisphosphonates, TCA’s, opioids contraversial!!!
Complex regional pain syndrome (CRPS) prognosis
-very disabling, only 15-20% return to work, many improve with combo of drug and PT, best treated early <6 months**
Compartment syndrome definition
Elevation of interstitial pressure in closed or fixed osseous or fascial compartment resulting in compromised microvascular perfusion, tissue hypoxia, and potentially irreversible damage to the contents, most often in the extremities (lower leg anterior (anterior tibial artery) and deep posterior compartments (deep peroneal artery) are concern)
Compartment syndrome pathophysiology (2)
- Increased compartment content (fracture, hemorrhage, penetrating trauma, edema)
- reduced volume (constriction by cast, burn, positional)
Chronic exertional compartment syndrome
Compartment syndrome with result of exercise, pain with repetitive overloading and relieved with rest, seen often in long distance runners, males and females, occurs frequently and consistently at a certain time during exercise with same level of exertion and same level of corresponding pain, treated with fascial release
Signs and symptoms of compartment syndrome (6)
- pain out of proportion
- tightness of compartment
- pain with passive ROM
- muscle weakness
- paresthesias
- skin changes consistent with ischemia
Compartment syndrome diagnosis (2)***
- clinical suspicion
- pressure monitor with stryker device >30mmHg or delta pressure <30 (diastolic - compartment)***
5 P’s of compartment syndrome
Pain Paresthesia Paralysis Pallor Pulselessness
Compartment syndrome treatment (2)
- early recognition and monitoring
- fasciotomy
