What is compartment syndrome?

A compartment syndrome occurs, for example, when tissue swells after an injury but cannot expand - because it is surrounded by a tight connective tissue covering or a bandage. This increases the pressure and damages the tissue

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What is compartment syndrome?

Tissue that is enclosed by a tight layer of connective tissue (fascia) is called a compartment.Classic compartments are, for example, some muscle groups on the arms and legs. Under certain circumstances (see below) the pressure in such a compartment increases. If this increase in pressure remains undetected and untreated, the affected tissue can perish. The technical term for this is compartment syndrome.

In principle, a compartment syndrome is possible in any region of the body in which tissue is completely enclosed by a less elastic envelope, like the muscle groups in the legs and arms by the fascia.

A special case is an increase in pressure in the abdomen - an abdominal compartment syndrome. The cause for this is usually a disease of the abdominal cavity such as an intestinal obstruction or an abdominal injury. Critically ill intensive care patients in particular can develop an abdominal compartment syndrome.

This article is limited to the classic compartment syndrome of the limbs.

Cause: What causes compartment syndrome?

Most often, compartment syndrome occurs as a complication after bone fractures (75 percent of cases). The risk of developing acute compartment syndrome appears to be increased for men under 35 years of age. In the majority of cases, the lower leg is affected. Accompanying muscle injuries increase the risk, as do multiple injuries (for example a so-called multiple trauma or burns). Compartment syndrome can also develop in injuries without a broken bone, such as bruises. Non-traumatic causes (without the use of force), such as thrombosis, are also less common.

What happens with a compartment syndrome?

Different factors work together in the development of a compartment syndrome. On the one hand, there is an increase in the volume in a compartment. Most of the time, this happens as a result of swelling or bruising in the area of ​​an injury. Other causes can be the infusion of large amounts of fluids, but also certain medications. Due to a changed blood flow in the affected area, the smallest vessels (capillaries) become more permeable for fluid that is in the blood vessels and fluid also escapes into the compartment (edema formation).

In addition, there is pressure from the outside, for example from a tight-fitting plaster cast. It prevents the tissue from expanding. That's why the pressure increases. Other possible causes are accompanying injuries: For example, a burn or frostbite can encompass the entire limb. An unfavorable position of the injured limb also sometimes leads to an increase in the pressure in the tissue.

Most often, compartment syndrome occurs 12 to 36 hours after an accident.

Symptoms and possible consequences: What symptoms does a compartment syndrome cause?

The main symptom of compartment syndrome is severe pain in the injured limb, beyond the level of pain that can be expected from the injury itself. Even strong painkillers can hardly relieve the pain. Severe pain is also typical with passive stretching. Swelling is especially visible in superficial compartments. Deeper tissues are more difficult to assess. Sensory disturbances below the affected region and disturbances in locomotor function are signs of a prolonged increase in pressure.

An untreated compartment syndrome can have serious consequences. The increase in pressure impairs the supply of oxygen and nutrients to the affected tissue. Muscle tissue can break down. The consequences of an untreated compartment syndrome range from permanent impairment of the function of the affected limb to its loss.

In the case of extensive muscle breakdown, there is also a risk of acutely life-threatening complications: When muscle tissue is destroyed, substances are released that can lead to the failure of vital organs (such as the kidney) (a so-called "crush syndrome").

Diagnosis: how is compartment syndrome diagnosed?

The most important pointers are the patient's complaints. Diagnosis is therefore particularly difficult in people who are unable to make contact for various reasons, for example because they are in an artificial deep sleep due to severe concomitant diseases.

The doctor draws conclusions from the examination results, i.e. the appearance, temperature and pulse of the limb. It is also possible to measure the pressure in the tissue directly. This requires measuring devices in which a hollow needle is connected to a pressure transducer. If the doctor sticks the needle into a muscle, he can read off the pressure that is there. The measured values ​​are particularly important as comparative values ​​over the course of the year. There are no absolute limit values ​​for a critical tissue pressure. As a rule, based on the clinical examination results, the doctor decides whether an operation is necessary or not.

Since the consequences of a compartment syndrome can be severe, immediate treatment is necessary if it is suspected.

Therapy: how is compartment syndrome treated?

Whenever a compartment syndrome is suspected, the doctor checks plaster casts and bandages and re-applies them if necessary. He also controls the positioning of the limbs.

If the symptoms cannot be influenced by these measures, an operation is necessary. Doctors open up the skin and the underlying connective tissue layer (fascia) over the entire length of the affected compartment so that the tissue can expand and prevent consequential damage. The wound is temporarily covered with synthetic materials. A final closure of the wound with a suture is usually possible after about one to two weeks.

Prognosis: What are the chances of recovery?

Compartment syndrome is an emergency surgical situation that must be treated without delay. With timely diagnosis and therapy, the prognosis is usually very good.

Dr. Niels Erasmus Krahn

Consulting expert:

Dr. med. Niels Erasmus Krahn, specialist in orthopedics and trauma surgery, is the senior physician at the BG Klinikum Duisburg.

Source:

  • The acute compartment syndrome, dissertation. Online: http://www-brs.ub.ruhr-uni-bochum.de/netahtml/HSS/Diss/KrahnNielsErasmus/diss.pdf (accessed on May 15, 2019)
  • Stracciolini A., Hammerberg E.M. Acute compartment syndrome of the extremities. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (accessed May 17, 2019)

Important NOTE:

This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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