What does it mean when increased intra-compartmental pressure within the thin casing of connective tissue that covers and holds muscles in place (fascia) is no longer elastic? And what happens when the resulting pressure decreases or restricts blood flow to muscles and nerves (ischemia)? What if there is potential to damage both types of cells as well?
There is compartment syndrome.
This painful and sometimes severe condition can be either acute or chronic. And both variations occur most frequently in the legs or arms. While the condition may be rare, it is important to recognise and understand facts that could help improve clinical outcomes. Here are six.
Video: Diagnosing Compartment Syndrome with Professor Paul Lee
1. Incorrect splinting is counterproductive
After experiencing physical trauma, it is crucial that healthcare staff apply the correct splinting process. That is, splints should stabilise the injury without adding undue pressure. Otherwise, it could result in additional strain on the area, contributing to compartment syndrome. Rechecking and adjusting the splint regularly is, therefore, necessary to manage swelling that may develop after the trauma.
2. Anabolic steroids and anticoagulants pose risks
With anticoagulants, normal clotting after trauma-related bleeding is impaired. This can contribute to a build-up of pressure, leading to compartment syndrome. Similarly, anabolic steroids can increase the risk of developing the condition, as it stimulates rapid growth of muscle tissue in less-elastic fascial sheaths. This means pressure is likely to increase. Athletes are most at risk of developing the condition in the form of anterior compartment syndrome, since they are more likely to take steroids for performance enhancement.
3. Only acute compartment syndrome is a medical emergency
This distinction is important. To have an accurate diagnosis of the nature of the compartment syndrome, physicians perform measurements of compartment pressure.
Intervention: If found to be acute, intervention is required as soon as possible. This means, unless surgery to cut and relieve tension or pressure (fasciotomy) takes place quickly, the increasing pressure may completely cut off blood flow. This could lead to the premature death of cells (necrosis) in the affected limb.
4. Chronic compartment syndrome should not be ignored
While this form may not be an immediate threat to life, it is best to consult a physician as soon as possible. Post-exercise pressure measurements can help confirm the diagnosis. As the more frequent occurring of the two, athletic overexertion is usually the cause.
Intervention: By means of miniature, digital pressure measurement instruments, exercise and rest, you can record intramuscular pressure. If the measured pressure reaches the critical threshold (30 mm Hg) and remains high five minutes after exercise, compartment syndrome is present. The first step afterwards is to discontinue exercise and/or physical therapy. Should these measures fail, surgery becomes a necessary form of treatment. Chronic exertional compartment syndrome (CECS) is a rare condition that usually affects long distance runners and other running athletes.
5. Compartment syndrome can also be present in the abdomen
The condition is often considered in relation to limbs, especially the legs. However, we’ve learned it can also present in the abdomen when an organ experiences severe dysfunction or failure. This is most common in critically ill patients or those who are afflicted by respiratory problems.
Intervention: To confirm this diagnosis, the pressure in the abdominal cavity requires assessment. Treatment would include the removal of anything restrictive to relieve pressure, mechanical ventilation, blood pressure medications and kidney therapies. If these fail, a fasciotomy is necessary.
6. Symptoms vary with acute, chronic and abdominal compartment syndrome
- Chronic compartment syndrome– Aching, tightening and cramping of the limb, numbness or tingling, weakness, swelling or bulging of the muscle and difficulty moving
- Acute compartment syndrome symptoms– Similar to the symptoms of chronic compartment syndrome, but with a greater degree or pain, possible burning sensation and discoloration
- Abdominal compartment syndrome symptoms– Distended or tense abdomen, pain or wincing when the abdomen is touched, low or no urine output, or low blood pressure.
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