Compartment Syndrome - Overview (signs and symptoms, pathophysiology, treatment)
Summary
TLDRThis video offers an in-depth introduction to compartment syndrome, focusing on acute cases affecting the leg. It explains the anatomy of leg compartments, the pathophysiology of increased pressure leading to compromised circulation and function, and the clinical signs of this condition. The script discusses diagnosis through the 'six P's' and emphasizes the importance of early detection and management, including potential surgical intervention with fasciotomy to alleviate pressure and prevent severe outcomes.
Takeaways
- 📚 Compartment syndrome is a condition where increased pressure within a muscle compartment compromises circulation and function.
- 🦿 It can be acute, often due to trauma, or chronic, affecting elite athletes, with the leg and forearm being common sites.
- 🦵 The leg has four compartments: posterior, lateral, anterior, and deep posterior, each containing muscles and neurovascular bundles.
- 💪 The fascia, a thick connective tissue, surrounds each compartment and individual muscles, forming small units of muscle bundles and fibers.
- 🚨 Acute compartment syndrome is a medical emergency characterized by severe pain, paresthesia, and potentially paralysis if not treated promptly.
- 🔁 The pathophysiology involves a cycle of increased pressure leading to reduced arterial supply, muscle cell death, and further edema, exacerbating the pressure.
- 🩺 Clinical diagnosis involves the 'six P's': pain, paresthesia, paralysis, pulse, pallor, and pressure, with pain being a key indicator.
- 🛑 Causes of acute compartment syndrome include fractures, thermal burns, crush injuries, penetrating injuries, and non-traumatic causes like thrombosis and drug use.
- 🧪 Diagnostic investigations may include full blood count, creatine kinase levels, urine analysis for myoglobin, and pressure measurement.
- 🩺 Management ranges from conservative treatment with hydration and pain relief to surgical intervention, such as fasciotomy, to relieve pressure.
- ⚠️ Fasciotomy involves making incisions to decrease compartment pressure, allowing for the restoration of blood flow and nerve function.
- 🦾 In severe cases where the limb is not viable, amputation may be necessary to prevent further complications.
Q & A
What is compartment syndrome?
-Compartment syndrome is a condition where there is an increase in pressure within a muscle compartment that compromises circulation and function to the tissues within that area.
How many compartments are there in the leg, and what are they?
-There are four compartments in the leg: the posterior compartment, the lateral compartment, the anterior compartment, and the deep posterior compartment.
What are the components within each muscle compartment?
-Within each compartment, there are muscles, neurovascular bundles (including the artery, vein, and nerve), and a thick fascia surrounding the muscle groups.
What is the pathophysiology behind acute compartment syndrome?
-Acute compartment syndrome is triggered by an inflammatory process and reaction due to direct muscle or arterial injury, causing fluid to shift into the muscles, leading to edema and increased pressure, which can reduce arterial supply and cause muscle death, further exacerbating the condition.
What are the clinical findings or 'six P's' associated with acute compartment syndrome?
-The 'six P's are: Pain, Paresthesia, Paralysis, Pallor, Pulse, and Pressure. Pain is often the first and most significant finding, and paralysis is usually the latest.
Why is it important to diagnose acute compartment syndrome promptly?
-Prompt diagnosis is crucial because if left untreated, acute compartment syndrome can lead to muscle death and permanent damage, potentially requiring limb amputation.
What are some common causes of acute compartment syndrome?
-Common causes include fractures, thermal burns, crush injuries, penetrating injuries, and non-traumatic causes such as thrombosis, bleeding disorders, vascular disease, and illicit drug use.
How is acute compartment syndrome managed if it is suspected?
-Immediate contact with a surgeon is necessary. Management can be conservative with hydration and urine output monitoring, but the main treatment is often surgical intervention, specifically a fasciotomy, to relieve pressure.
What is a fasciotomy, and why is it performed in cases of acute compartment syndrome?
-A fasciotomy is a surgical procedure where the fascial layer is切开 to decrease pressure within the affected compartment, allowing for proper blood flow and nerve function.
What investigations may be used to diagnose acute compartment syndrome?
-Investigations may include full blood count, creatine kinase levels (which are raised due to muscle damage), urine analysis for myoglobin (which can indicate rhabdomyolysis), and pressure measurement by surgeons to assess severity.
How can rhabdomyolysis be related to acute compartment syndrome?
-Rhabdomyolysis, the injury or damage to muscle tissue, can lead to similar findings as acute compartment syndrome, including elevated creatine kinase and myoglobin levels, and may result in a compartment syndrome due to muscle injury.
Outlines
🏥 Introduction to Compartment Syndrome
This paragraph introduces the concept of compartment syndrome, focusing on acute cases affecting the leg, though the principles apply to other body parts. It explains that muscles are divided into compartments and compartment syndrome occurs when pressure within a compartment increases, affecting circulation and function. The paragraph outlines the different types of compartment syndrome, with an emphasis on the acute form, and describes the compartments of the leg, including the anterior, lateral, and two posterior compartments. It also discusses the anatomy of muscles and the role of fascia in compartment syndrome, leading to a buildup of pressure and potential complications if not treated.
🚑 Understanding Acute Compartment Syndrome
This paragraph delves into the pathophysiology of acute compartment syndrome, describing how direct muscle damage or arterial injury can trigger an inflammatory response, leading to fluid accumulation and increased pressure within the muscle compartment. It explains the vicious cycle of reduced arterial supply, tissue death, and further inflammation. The paragraph also covers the signs and symptoms of acute compartment syndrome, including severe pain, paresthesia, and the 'six P's' of clinical findings: pulse, paresthesia, pain, pallor, pressure, and paralysis. It discusses the causes of acute compartment syndrome, such as fractures, burns, and drug abuse, and outlines the necessary investigations, including blood tests for creatine kinase and urine analysis for myoglobin, as well as the potential need for pressure measurement.
⚕️ Management and Treatment of Compartment Syndrome
The final paragraph discusses the management of acute compartment syndrome, emphasizing the importance of early suspicion and contact with a surgeon. It outlines conservative management strategies, such as hydration and alkalization, to flush out toxic substances like creatine kinase and myoglobin that can be harmful to the kidneys. The main treatment is fasciotomy, a surgical procedure that involves making incisions to release pressure within the affected compartments. The goal is to make the fewest possible cuts to achieve this, with incisions typically made on either side of the tibia to address all four leg compartments. The paragraph concludes with a mention of limb amputation as a last resort if the limb is deemed non-viable due to late detection or gangrene.
Mindmap
Keywords
💡Compartment Syndrome
💡Acute Compartment Syndrome
💡Compartments
💡Neurovascular Bundles
💡Fascial Layer
💡Pathophysiology
💡Rhabdomyolysis
💡Fasciotomy
💡Clinical Findings
💡Etiology
💡Investigations
Highlights
Compartment syndrome is an overview and introduction, focusing on the leg affected by acute compartment syndrome.
Muscle groups in human limbs are divided into compartments, and compartment syndrome occurs when pressure within a compartment increases, compromising circulation and function.
Acute compartment syndrome can result from trauma or be chronic in elite athletes, with the leg and forearm being common sites.
The leg has four compartments, each with muscles and neurovascular bundles, surrounded by fascia.
In compartment syndrome, increased pressure leads to compression of neurovascular bundles, potentially causing severe consequences.
Pathophysiology of compartment syndrome involves a cycle of increased pressure, reduced arterial supply, and further edema, leading to muscle death and inflammation.
Clinical findings for acute compartment syndrome include the six P's: pulse, paresthesia, pain, pallor, pressure, and paralysis.
Acute compartment syndrome can be caused by fractures, thermal burns, crush injuries, penetrating injuries, and non-traumatic causes like thrombosis and bleeding disorders.
Investigations for compartment syndrome include full blood count, creatine kinase levels, urine analysis for myoglobin, and pressure measurement.
Management of acute compartment syndrome involves suspicion, immediate contact with a surgeon, and may require conservative or surgical treatment.
Conservative management includes hydration, urine output monitoring, and alkalization to flush out toxic creatine kinase and myoglobin.
Surgical treatment, known as fasciotomy, involves making incisions to decrease compartment pressure, allowing for proper blood and nerve flow.
Fasciotomy aims to make the least number of cuts to decrease pressure in all compartments, with incisions made on either side of the tibia for leg compartments.
If detected too late and gangrene is present, limb amputation may be performed as a last resort.
Rhabdomyolysis, a condition of muscle tissue damage, can lead to similar findings as acute compartment syndrome and requires monitoring for myoglobin in urine.
The importance of early detection and intervention in acute compartment syndrome to prevent devastating outcomes is emphasized.
Morphine is crucial for pain relief in the management of acute compartment syndrome.
Transcripts
hello in this video we're going to talk
about
compartment syndrome this is an overview
and introduction in this specific video
we're gonna talk about the leg affected
by acute compartment syndrome but the
same principles apply to any part of the
body essentially before moving on it is
important to know that the muscle groups
of the human limbs are divided into
sections or compartments and so
compartment syndrome occurs when there's
increased in pressure within a
compartment which compromises
circulation and function to the tissues
within that area compartment syndrome
can actually be acute such as from
trauma or chronic which occurs in elite
athletes or we are mainly concentrating
on acute compartment syndrome and the
common sites for acute compartment
syndrome is the leg as well as the
forearm here I'm drawing the leg of a
person and on the right we can see
obviously an enlarged leg which is meant
to represent a compartment syndrome
before going into acute compartment
syndrome let us talk about the
compartments of the leg as an example in
reality it can be any compartment such
as in the forearm or the thigh we're
just using a leg in this video remember
so first let us look at normal
compartments in a leg to get an idea so
here is a cross-section of the leg here
is the tibia bone in T and the fibula
bone in F these are the bones of the leg
now the muscle components of the leg can
be divided into four we will not look at
what the names of the muscles are within
the compartments we will mainly focus on
the compartments themselves now the leg
compartments include a posterior
compartment the lateral compartment the
anterior compartment and another
posterior compartment this one is the
deep posterior compartment whereas the
previous one was the superficial
posterior compartment which includes the
soleus and the gastroc muscles so in
summary the leg has four compartments
and in each compartment you have muscles
that run through them within each
compartment you also have neurovascular
bundles which includes the artery the
vein and the nerve why is this so that
the muscles can be supplied by them each
compartment has a thick fasciae around
it but fashio
also surrounds each individual muscle
here is an example of a muscle with
fashio around it the muscle is made up
of small units of muscle bundles which
are also surrounded by fashio each
muscle bundle is made up of even smaller
units called muscle fibers these are the
muscle cells the muscle all together
supplied by nerves arteries and veins
that supply that area in a queue
compartment syndrome there is a build up
in pressure in one or more compartments
of a particular limb in this case the
leg here is a diagrammatical
representation of all the compartments
in the leg swelling up because of the
increase in pressure this increase in
pressure that we see in compartment
syndrome leads to compression of the
neurovascular bundles which further
increases the pressure and also can lead
to devastating consequences if not
corrected the pathophysiology behind
compartment syndrome to put it simply
here in blue is the vein that drains
from the muscle and from the extremities
here in red is the artery that supplies
the muscle with oxygen and here in
yellow in the middle is the muscle
itself the compartment essentially many
things can trigger acute compartment
syndrome a let us say for the simplicity
sake there is direct damage to the
muscle or arterial injury in the muscle
this will all cause some form of
inflammatory process and reaction which
will eventually cause fluid to shift
into the muscles causing compartment
edema this increases the pressure when
there is increase in pressure eventually
the arterial supply
we'll be reduced to that area because
blood cannot go through and this will
eventually lead to the death and the
closest of that area when there's death
of the cells this further triggers an
inflammatory reaction causing further
edema and further increasing compartment
pressure it's like a vicious cycle what
actually aggravates this whole process
even more is when the increase in
pressure in the muscle compartment
actually inhibits the drainage of the
veins from the distal extremities
because the veins cannot drain properly
it just pulls the blood pools closing
further edema and this can occur in the
extremities as well as in the
compartment and all this will further
increase pressure the lymphatics will
initially try to compensate by draining
some of this fluid but it is soon
overwhelmed and so with this buildup in
pressure and inflammation process we see
the signs and symptoms of acute
compartment syndrome which includes
mainly pain out of proportion to the
apparent injury paresthesia and deep
burning constant pain what is more
important is the clinical findings
history examination is very important
for acute compartment syndrome
examination involves looking at the six
P's these six P's include pulse pulse
can be present even with acute
compartment syndrome paresthesia is
common pain is probably the most
important initial finding pain can even
be aggravated by passive stretching of
the affected compartment for example if
there is posterior compartment
involvement dorsiflexion will stretch
the posterior compartment aggravating
the pain on the posterior compartment
similarly acute compartment syndrome
occurring in the anterior leg
compartment can be aggravated by plantar
flexing which stretches that compartment
tala is the fourth P and in compartment
Paulo is uncommon what is more common is
pink because the limit still has some
form of blood supply v P is pressure
pressure includes pain when touching the
affected limb also very important
patients with acute compartment syndrome
is often described as feeling would like
on palpation because of the increase in
pressure the final sixth P is paralysis
which is the latest finding we briefly
looked at the pathophysiology the signs
and symptoms and clinical examination of
acute compartment syndrome let us look
at what can cause acute compartment
syndrome some of these are also the risk
factors the etiology or cause of acute
compartment syndrome include fractures
which make up the majority 75% of cases
thermal burns crush injury penetrating
injury non-traumatic causes of acute
compartment syndrome are less common and
include thrombosis bleeding disorders
and vascular disease finally illicit
drug use chronic use abuse is also a
cause because of the use of toner case
or injury by needle puncture
investigations include full blood count
creating kinase which is raised because
of the damage to the muscle cells it is
important to remember rhabdomyolysis in
this case
rhabdomyolysis is where you have injury
or damage to muscle tissue this leads to
similar findings to acute compartment
syndrome
rhabdomyolysis also has elevated
creatine kinase rhabdomyolysis can lead
to a two compartment syndrome because it
is essentially muscle injury in
rhabdomyolysis myoglobin is also
increased in urine and so another
investigation for a to compromise
syndrome suspicion is urine analysis
using dipstick which will show red blood
cells which correlates to the myoglobin
in this case finally a pressure
measurement may be used which is
mainly done by surgeons to assess
severity and the need to operate the
management of acute compartment syndrome
is important always have a suspicion of
a two compartment syndrome if someone
presents with acute muscle pain with the
background of a fracture immediate
contact to a surgeon is necessary if
acute compartment syndrome is suspected
and the management will really depend on
what the surgeon wants to do it can be
conservative if not too serious that is
improving it is important to hydrate and
achieve urine output for adults greater
than 0.5 milliliters per kilogram per
hour plus - you're on alkalization the
problem is that elevated seek creating
kinase and myoglobin is actually toxic
to the nephron to the kidneys and so you
want to flush it out
morphine is also important for pain
relief but the main form of treatment is
surgery which is a fasciotomy and as the
name suggests it's essentially opening
up the fascial layer the main goal of
fasciotomy is to decrease the pressure
in that compartment that the fascist
surrounds for example let's go back to
the same scenario the same image where
we have all the compartments of the leg
having increased pressure a fasciotomy
aims to make the least number of cuts to
the body to decrease the compartment
pressure for the leg therefore the
incisions are made on either side of the
tibia which will cover all four
compartments and thus decrease pressure
in all four compartments zooming in by
performing a fasciotomy pressure is
decreased in the compartment which will
allow proper flow of arteries and veins
and nerves that were previously
compressed finally if the surgeon thinks
the limb is not viable because it was
detected too late for example and there
is gangrene then the limb amputation is
performed
you
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