Compartment Syndrome Lecture Powerpoint

Question 1

Complex regional pain syndrome

Answer 1

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

Question 2

CRPS (Complex regional pain syndrome) type I vs II

Answer 2

• 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

Question 3

5 Characteristics of CRPS (Complex regional pain syndrome)**

Answer 3

• 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)

Question 4

Diagnostic criteria for Complex regional pain syndrome (4)

Answer 4

• Clinical
• continuing pain disproportionate to inciting event
• displays at least one of the 5 characteristics
• no other diagnosis better explains

Question 5

Complex regional pain syndrome (CRPS) stages

Answer 5

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

Question 6

Imaging considerations in Complex regional pain syndrome (CRPS) (3)

Answer 6

• Bone scinitigraphy (bone scan) can support diagnosis but not rule out
• radiograph can demonstrate osteoperosis but sensitivity is low
• autonomic testing

Question 7

Complex regional pain syndrome (CRPS) treatment options (4)

Answer 7

• PT and OT 1st line***
• psychosocial and behavioral therapy
• interventional pain management such as nerve blocks
• NSAIDs, gabapentin, bisphosphonates, TCA’s, opioids contraversial!!!

Question 8

Complex regional pain syndrome (CRPS) prognosis

Answer 8

-very disabling, only 15-20% return to work, many improve with combo of drug and PT, best treated early <6 months**

Question 9

Compartment syndrome definition

Answer 9

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)

Question 10

Compartment syndrome pathophysiology (2)

Answer 10

• Increased compartment content (fracture, hemorrhage, penetrating trauma, edema)
• reduced volume (constriction by cast, burn, positional)

Question 11

Chronic exertional compartment syndrome

Answer 11

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

Question 12

Signs and symptoms of compartment syndrome (6)

Answer 12

• pain out of proportion
• tightness of compartment
• pain with passive ROM
• muscle weakness
• paresthesias
• skin changes consistent with ischemia

Question 13

Compartment syndrome diagnosis (2)***

Answer 13

• clinical suspicion

- pressure monitor with stryker device >30mmHg or delta pressure <30 (diastolic - compartment)***

Question 14

5 P’s of compartment syndrome

Answer 14

Pain
Paresthesia
Paralysis
Pallor
Pulselessness

Question 15

Compartment syndrome treatment (2)

Answer 15

• early recognition and monitoring

- fasciotomy

Question 16

Preferred pain relief for compartment syndrome

Answer 16

• Fentanyl (doesn’t vasoconstrict or vasodilate)

- do not ice or elevate!

Question 17

Compartment syndrome sequelae (3)

Answer 17

• Tissue damage
• amputation
• renal failure and or death

Question 18

Osteomyelitis definition

Answer 18

Infection of the bone, either nonhematogenous (direct, adjacent spread) or hematogenous (seeds to bone)

Question 19

Osteomyelitis risk factors (6)

Answer 19

• open fractures (multiple organisms involved)
• IV drug use
• sickle cell (most often salmonella)
• Peripheral vascular disease in diabetics
• joint prosthesis
• cellulitis or burns

Question 20

Osteomyelitis signs and symptoms (6)

Answer 20

• dull pain with or without movement
• fever or rigors
• irritability, fatigue, gait changes, refusal to weight bear
• hip, vertebrae, and pelvis have fewer symptoms
• long bones hematologic spread most common in children
• vertebral most common in adults

Question 21

Osteomyelitis diagnostic studies (4)

Answer 21

• Nonspecific labs (WBC, ESR)
• radiographs in >2 week long infection
• MRI in <2 weeks long infection
• Bone biopsy for culture (gold standard)**

Question 22

Organisms responsible for osteomyelitis in infants, children, and adults

Answer 22

• GBS, staph aureus, e coli
• staph aureus, strep pyogenes, hemophilus influenza
• S aureus, pseudomonas/serratia

Question 23

Osteomyelitis treatment options (3)

Answer 23

• antibiotics IV and IM
• surgical debridement
• remove prosthesis and don’t replace until sterility