Compartment Syndrome - Overview (signs and symptoms, pathophysiology, treatment)

Summary

This 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

00:00

🏥 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.

05:01

🚑 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.

10:02

⚕️ 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.

Keywords

💡Compartment Syndrome

Compartment Syndrome is a medical condition where pressure within a muscle compartment increases to a level that compromises blood flow and function of the tissues within that area. In the context of the video, acute compartment syndrome is the focus, particularly when it affects the leg. It is a critical condition that requires timely intervention to prevent severe outcomes such as tissue death and limb amputation.

💡Acute Compartment Syndrome

Acute Compartment Syndrome refers to a sudden increase in pressure within a muscle compartment, often resulting from trauma or injury. The video emphasizes its occurrence in the leg, explaining that it can lead to severe pain and potentially require surgical intervention, such as fasciotomy, to relieve the pressure and restore blood flow.

💡Compartments

In the script, compartments are the distinct sections within the limbs that contain muscle groups, nerves, and blood vessels. The leg, for example, is divided into four compartments: anterior, lateral, superficial posterior, and deep posterior. The concept is central to understanding compartment syndrome as the increased pressure within any of these compartments can lead to the condition.

💡Neurovascular Bundles

Neurovascular Bundles are the collective term for the nerve, artery, and vein that run through each muscle compartment. The video explains that these bundles are crucial for supplying the muscles with oxygen and nutrients and removing waste. In compartment syndrome, the increased pressure can compress these bundles, exacerbating the condition.

💡Fascial Layer

The fascial layer is a thick connective tissue that surrounds the muscle compartments and individual muscles. The script mentions fascia in the context of compartment syndrome, where the fascial layer's inelastic nature contributes to the increased pressure within the compartment when there is swelling or edema.

💡Pathophysiology

Pathophysiology in the video refers to the underlying physiological mechanisms and processes that lead to compartment syndrome. It includes the inflammatory response, fluid shift into the muscles, and the resulting increase in pressure that can compromise blood flow and lead to tissue damage.

💡Rhabdomyolysis

Rhabdomyolysis is a condition characterized by injury or damage to muscle tissue, leading to the release of myoglobin into the bloodstream. The video script mentions it as a potential complication of compartment syndrome, where elevated creatine kinase and myoglobin levels indicate muscle damage.

💡Fasciotomy

Fasciotomy is a surgical procedure that involves making incisions into the fascial layer to relieve pressure within a muscle compartment. The video describes it as the primary treatment for acute compartment syndrome, with the goal of restoring blood flow and preventing further tissue damage.

💡Clinical Findings

Clinical findings in the context of the video refer to the observable signs and symptoms that suggest the presence of compartment syndrome. These include the 'six P's': pain, paresthesia, pulse, pallor, pressure, and paralysis. The script emphasizes the importance of a thorough clinical examination in diagnosing the condition.

💡Etiology

Etiology in the script refers to the causes of acute compartment syndrome. The video lists several causes, including fractures, thermal burns, crush injuries, penetrating injuries, non-traumatic causes like thrombosis, bleeding disorders, vascular disease, and illicit drug use.

💡Investigations

Investigations in the video are the diagnostic tests used to confirm the presence of compartment syndrome or related conditions like rhabdomyolysis. The script mentions full blood count, creatine kinase levels, urine analysis for myoglobin, and pressure measurement as part of the diagnostic process.

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