From the Guidelines
Compartment syndrome is a serious medical condition that occurs when pressure builds up within a confined space or compartment in the body, typically in the arms or legs, and requires immediate medical attention to prevent long-term complications. This increased pressure restricts blood flow to muscles and nerves, causing tissue damage and potentially permanent disability if not treated promptly. The condition can be acute (developing rapidly after an injury) or chronic (developing over time with repetitive activities). Symptoms include severe pain that seems disproportionate to the injury, pain that worsens with passive stretching of the affected muscles, tenseness or hardness of the compartment, numbness or tingling, and weakness in the affected area. The most common causes include fractures, crush injuries, tight bandages or casts, burns, or excessive exercise.
Causes and Risk Factors
The development of compartment syndrome is often associated with:
- Fractures
- Crush injuries
- Tight bandages or casts
- Burns
- Excessive exercise According to 1, prophylactic fasciotomies at the time of revascularization or early in the presentation can avoid a later delay in diagnosis of compartment syndrome and devastating complications associated with this delayed diagnosis.
Diagnosis and Treatment
Treatment for acute compartment syndrome typically requires emergency fasciotomy surgery, where the surgeon cuts open the affected compartment to relieve pressure. Without timely intervention, compartment syndrome can lead to permanent muscle damage, loss of limb function, or even necessitate amputation in severe cases. As noted in 1, the diagnosis of compartment syndrome is based on the history and associated clinical findings, and a high clinical suspicion is necessary to permit early diagnosis and timely decompression with surgical fasciotomy.
Importance of Early Intervention
Early diagnosis and treatment are crucial for preventing long-term complications. As stated in 1, monitoring for compartment syndrome is an important component of care for patients with acute limb ischemia, and immediate fasciotomy is indicated for patients with clinical evidence of compartment syndrome.
Key Points to Remember
- Compartment syndrome is a medical emergency that requires prompt attention
- Early diagnosis and treatment are crucial for preventing long-term complications
- Fasciotomy surgery is typically required to relieve pressure and restore blood flow to the affected area
- Patients with symptoms of compartment syndrome should seek immediate medical attention, as delayed treatment can lead to permanent damage or amputation, as highlighted in 1 and 1.
From the Research
Definition of Compartment Syndrome
- Compartment syndrome is a condition where pressure within a closed muscle compartment exceeds the perfusion pressure, resulting in muscle and nerve ischemia 2.
- It involves a conflicting situation between an unyielding space, the compartment, and its increasing tissue content secondary to traumatic ischemia 3.
- Acute compartment syndrome (ACS) is defined as a clinical entity originated from trauma or other conditions, and remains challenging to diagnose and treat effectively 4.
Types of Compartment Syndrome
- Two distinct conditions are recognized: acute and chronic (exertional) compartment syndromes 2.
- Acute compartment syndrome can occur in many body regions and may range from homeostasis asymptomatic alterations to severe, life-threatening conditions 5.
Causes and Risk Factors
- Compartment syndrome can be caused by trauma or other conditions, and is associated with a number of risk factors, including fractures or trauma to the involved area 6.
- The presence of clinical assessment (5P) always means the necrosis of muscles and was the most serious or irreversible stage of ACS 4.
Diagnosis and Treatment
- Diagnosis of compartment syndrome is clinical in priority, but pressure measurements should be systematically produced to confirm the presence of this condition and define optimal surgical strategies 3.
- Immediate surgical fasciotomy is important to prevent severe sequelae of the ACS, but the right time to perform fasciotomy is still controversial 4.
- Treatment involves surgical consultation for emergent fasciotomy, as well as resuscitation and management of complications, such as rhabdomyolysis 6.