By Andrea K. Walker, The Baltimore Sun
2:30 PM EDT, July 10, 2013
Our muscles and organs are divided into compartments held together by connective tissue. Damage to the compartments can cause a condition called compartment syndrome, which can cause painful swelling. Dr. Daryl Osbahr, an orthopedic surgeon at Union Memorial Hospital, said if the condition isn't treated soon enough, it can cause long-term damage.
What is compartment syndrome and what causes it?
Compartment syndrome occurs when an insufficient amount of blood is distributed to other structures within that compartment or enclosed space resulting in a lack of oxygen and nutrients within that area of the body, including the arm, leg, or any other enclosed space.
Compartment syndrome will often manifest in one of two distinct clinical presentations: acute compartment syndrome and chronic exertional compartment syndrome.
Acute compartment syndrome will typically occur after a traumatic event, requires immediate evaluation and treatment, and can be limb- and life-threatening.
Chronic exertional compartment syndrome will often present in a delayed fashion in physically active individuals and is not typically limb- or life-threatening; however, the clinical symptoms can result in significant pain and limitation of function, especially in athletes.
What are the symptoms of compartment syndrome?
The symptoms are usually classified according to the six classic "Ps," including pain out of proportion to what is expected based on the physical examination findings; passive stretch pain of the structures within the compartment; and paresthesia, pallor, paralysis and pulselessness. These symptoms will typically present in a characteristic order with a time-dependent increase in disease severity resulting in a worse prognosis, including irreversible damage. The early clinical signs of compartment syndrome will present as numbness, tingling and paresthesias and must be suspected especially in patients with pain out of proportion to the examination findings or passive stretch pain of the structures within the compartment. Late and potentially irreversible signs of compartment syndrome include pallor, paralysis and pulselessness, and can result in significant loss of function.
In acute compartment syndrome, the progression of symptoms can occur quickly, requiring expeditious and emergent treatment; however, chronic exertional compartment syndrome will often manifest during physical activity and typically present in a delayed fashion, requiring implementation of a thoughtful treatment plan.
Who typically gets compartment syndrome?
Acute compartment syndrome will usually present in trauma patients who have experienced high-energy injuries. However, relatively benign injuries may also result in increased compartment pressures due to bleeding or swelling and must be considered appropriately.
Chronic exertional compartment syndrome will typically manifest in physically active individuals, including recreational and competitive athletes. The diagnosis can sometimes be elusive, and the clinician should maintain a high index of suspicion, especially in cases of exertional related symptoms.
What are the dangers of compartment syndrome?
The dangers of compartment syndrome may be profound. If not treated expeditiously, acute compartment syndrome may result in significant nerve and muscle damage, potentially resulting in loss of limb or life. For chronic exertional compartment syndrome, prolonged symptomatology in the setting of inadequate treatment can lead to chronic pain and diminished function; however, patients should be monitored appropriately as acute compartment syndrome may develop resulting in significant consequences.
How is the disease treated?
In acute compartment syndrome, the diagnosis is mostly clinical, but compartment pressure testing to measure your compartment pressures is usually performed. Emergent fasciotomy (releasing the covering of the enclosed space) is the mainstay of treatment to relieve pressure and prevent secondary irreversible damage to other structures, including muscles and nerves.
In chronic exertional compartment syndrome, nonoperative treatment is typically first-line management. If symptoms continue, then the diagnosis is confirmed with exertional compartment pressure testing, where your clinician may use needles to measure your compartment pressures at rest, immediately after activity (typically utilizing a treadmill), and in a delayed fashion after activity. If the diagnosis is confirmed, fasciotomy is then performed for the necessary compartments.
What are some of the worst cases of the disease you have seen?
For acute compartment syndrome, the worst cases typically occur after violent trauma, including motor vehicle accidents, and require a dedicated team for prompt and expeditious recognition and treatment to prevent serious secondary sequelae.
In my orthopedic sports medicine practice, chronic exertional compartment syndrome is more often seen as athletes experience pain and dysfunction during recreational or competitive activities. The worst cases of the disease will typically result from misdiagnosis or the patient not seeking prompt evaluation, resulting in a prolonged course of pain and inability to perform some daily or sporting activities.
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