Compartment syndrome

Compartment syndrome usually presents within a few hours of an inciting event, but it may present anytime up to 48 hours after. Usually, NSAIDs cannot relieve the pain. High compartment pressure may limit the range of motion. In acute compartment syndrome, the pain will not be relieved with rest. Acute There are five signs and symptoms of acute compartment syndrome. It may be due to nerve damage from ischemia. The pain is aggravated by passively stretching the muscle group within the compartment. This pain can last for months or even years, but rest may relieve it. CECS most often occurs in the lower leg. ==Causes==

Acute Acute compartment syndrome (ACS) is a medical emergency. Examples include a severe crush injury or an open or closed fracture of an extremity. It can also affect the thigh, buttock, hand, abdomen, and foot. Leg compartment syndrome occurs in 1–10% of tibial fractures. Direct injury to blood vessels can reduce blood flow to soft tissues, causing compartment syndrome. Patients on anticoagulant therapy, or those with blood disorders such as hemophilia or leukemia are at higher risk of developing compartment syndrome. Compartment syndrome after snake bite is rare. Its incidence varies from 0.2% to 1.36% as recorded in case reports. Compartment syndrome after a snake bite is more common in children. Chronic Chronic compartment syndrome (CCS) is when repeated use of the muscles causes compartment syndrome. This is usually not an emergency, but loss of circulation can damage nearby nerves and muscles. CECS is often a diagnosis of exclusion. CECS of the leg is caused by exercise. This condition occurs commonly in the lower leg and various other locations within the body, such as the foot or forearm. CECS can be seen in athletes who train rigorously in activities that involve constant repetitive actions or motions. ==Pathophysiology==

ACS is defined as a critical pressure increase within a confined compartmental space causing a decline in the perfusion pressure to the tissue within that compartment. It must go from the higher-pressure arterial system to the lower-pressure venous system. This swells the extracellular space and raises the pressure in the compartment. The swelling of the soft tissues around the blood vessels compresses the blood and lymphatic vessels. Permanent damage can occur 12 hours after the injury starts. The reduced blood supply can trigger inflammation. This can cause the soft tissues to swell. Reperfusion therapy can worsen this inflammation. The fascia that defines the limbs' compartments does not stretch. Even a small bleed or muscle swelling can greatly raise the pressure. The pathophysiology of CECS is not entirely understood. In CECS, pressure in an anatomical compartment increases due to a 20% increase in muscle volume. This builds pressure in the tissues and muscles, causing ischemia. Increased muscle weight reduces the compartment volume of the surrounding fascial borders, raising compartment pressure. An increase in the pressure of the tissue can force fluid to leak into the interstitial space (extracellular fluid), leading to a disruption of the micro-circulation of the leg. ==Diagnosis==

Compartment syndrome is a clinical diagnosis. NIRS uses sensors on the skin. The best test is to measure intracompartmental pressures after running, when symptoms return. ==Treatment==

Acute If external compression, such as a cast or tourniquet, has caused increased pressure, it is removed and the limb placed at heart level. Otherwise, fasciotomy, a cut into the fascia beneath the skin, immediately decreases pressure and is generally the only effective treatment. Fasciotomy is often not necessary when compartment syndrome is caused by snake bites, where pressure may instead be relieved with antivenom. Chronic Chronic exertional compartment syndrome can be treated by reducing or stopping exercise-related activities, massage, non-steroidal anti-inflammatory medication, and physiotherapy. ==Prognosis==

Researchers have reported a mortality rate of 47% for acute compartment syndrome of the thigh. A study showed the fasciotomy rate for acute compartment syndrome ranges from 2% to 24%. After a fasciotomy, some symptoms may be permanent. Without enough oxygen, the tissue will die. It is permanent and irreversible. Rhabdomyolysis and kidney failure are also possible. Some case series report rhabdomyolysis in 23% of patients with ACS. ==Epidemiology==

In a case series of 164 people with acute compartment syndrome, 69% had an associated fracture. The article's authors found that the yearly rate of acute compartment syndrome is 1 to 7.3 cases per 100,000 people. == In children ==

The pathophysiology of acute compartment syndrome in children is the same as adults. However, cases are complicated by challenges in examination and communication with pediatric patients. In addition, it can take longer to develop high pressures in pediatric compartments. Besides the "5 Ps," the "3 As" can diagnose compartment syndrome in children: increasing anxiety, agitation, and analgesic needs. Normal compartment pressures in children are typically higher than adults. The most common cause of compartment syndrome in children is traumatic injury. In children 14 years of age, the cause is usually due to trauma or surgical positioning. Treatment for compartment syndrome in children is the same as adults. == See also ==