Compartment Syndrome
Published: 13 June 2022
Published: 13 June 2022
Compartment syndrome is an extremely painful condition that if presenting acutely is a medical emergency. Left untreated, it can result in serious consequences such as ischaemia, necrosis, amputation of the affected limb or even death (Torlincasi et al. 2022; Cleveland Clinic 2021).
Note: This Article will focus on the acute form of compartment syndrome.
The arms and legs are divided into several segments known as fascial compartments. Each compartment comprises a group of muscle tissue, blood vessels and nerves contained within a strong membrane known as the fascia (Delgado & Morrison 2018).
The fascia is inelastic, preventing the compartments from rapidly expanding. Compartment syndrome is when blood or fluid accumulates in the intracompartmental space and the compartment is unable to stretch to accommodate this increased fluid volume, causing a high level of pressure, which in turn, impedes perfusion to the affected area (Torlincasi et al. 2022; ACI 2018).
Compartment syndrome most commonly occurs in the anterior compartment of the leg, but can also affect the forearm, thigh, buttock, shoulder, hand or foot (Physiopedia 2015).
There are two types of compartment syndrome: acute and chronic.
(Cleveland Clinic 2021; NHS 2019)
Potential causes of acute compartment syndrome include:
(Hammerberg 2022; Healthdirect 2020; ACI 2018; Torlincasi et al. 2022)
Rarely, acute compartment syndrome can present without any signs of injury (NHS 2019).
Those at increased risk of compartment syndrome include:
(Torlincasi et al. 2022; ACI 2018)
The onset of symptoms is typically within a few hours after sustaining trauma, however, in some cases, symptoms can develop up to 48 hours later (Torlincasi et al. 2022).
A patient with compartment syndrome may present with:
(Torlincasi et al. 2022; TeachMe Surgery 2022; Hammerberg 2022)
Compartment syndrome is typically identified via clinical diagnosis based on symptoms and risk factors, as prompt treatment is crucial (Torlincasi et al. 2022; TeachMe Surgery 2022).
Physical examination should involve:
(Torlincasi et al. 2022; Physiopedia 2021)
Traditionally, compartment syndrome has been diagnosed using the 'six Ps’ of arterial insufficiency:
(Ovalle Jr & Megee 2019)
The six Ps are now considered clinically unreliable as aside from pain, they may only occur in the later stages of compartment syndrome by the time irreversible tissue damage has already occurred (Rasul Jr 2020; Hammerberg 2022).
The most reliable diagnostic method for compartment syndrome is measuring the intracompartmental pressure (ICP) of the affected area using a manometer or slit catheter. While this is not a necessary test, it can assist in confirming a diagnosis if uncertainty exists (Torlincasi et al. 2022; TeachMe Surgery 2022).
An ICP of over 30 mmHg indicates compartment syndrome (normal pressure is between 0 mmHg and 8 mmHg) (Torlincasi et al. 2022).
Other diagnostic tests that might be used include:
(Torlincasi et al. 2022; TeachMe Surgery 2022)
Note: Due to the severity of the condition and the potential for limb loss, treatment should be prioritised with less time spent on confirming the diagnosis (Torlincasi et al. 2022).
Once compartment syndrome is suspected, management steps might include:
(Torlincasi et al. 2022; TeachMe Surgery 2022)
Compartment syndrome is treated using a surgical procedure known as a fasciotomy, wherein the skin is cut down to the fascia to release the accumulated pressure. The incision is then left open for several days to prevent the intracompartmental pressure from increasing again before being closed (ACI 2018).
Whether or not a fasciotomy is indicated generally depends on the ICP in the affected compartment and the amount of time that has elapsed since the trauma occurred, as if the injury is left untreated for too long, irreversible damage may have already ocurred (Torlincasi et al. 2022).
If necrosis has already occurred before a fasciotomy can be performed, an infection may be present. This may require debridement or even amputation to prevent systemic spread (Torlincasi et al. 2022).
The sooner a fasciotomy is performed, the more likely the patient is to recover their limb function. If left untreated for too long, the patient may experience residual nerve damage (Torlincasi et al. 2022).
Postoperative care might involve:
(Torlincasi et al. 2022)
Potential complications of compartment syndrome and fasciotomy include:
(Torlincasi et al. 2022)
Question 1 of 3
Where in the body does compartment syndrome most commonly occur?