Compartment syndrome

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Compartment syndrome

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Transcript

Content Reviewers

Yifan Xiao, MD

Contributors

Rachel Yancey

Samantha McBundy, MFA, CMI

Zachary Kevorkian, MSMI

With compartment syndrome, compartment refers to separate sections of the body that contain muscles, nerves, and blood vessels surrounded by a layer of fibrous connective tissue, called fascia.

When the pressure within these compartments rises, normal blood flow can be cut off, leading to tissue damage due to hypoxia, or the lack of oxygen.

Compartment syndrome typically happens in the limbs, usually in the lower leg or the forearm.

Now, if we remove the skin and then we remove the fat tissue from the lower leg, we would uncover the fascia.

Fascia surrounds the muscles, keeping them tightly together while they contract to move the limb, and it also help attach these muscles to the bones.

Now if we look at a cross section of the lower leg, we can see that the fascia sends intermuscular septa that together with the interosseous membrane between the tibia and fibula divide the lower leg into four compartments.

The anterior, lateral, deep posterior and superficial posterior compartments all contain their own muscles, and blood vessels.

For example, the anterior compartment holds the muscles that perform dorsiflexion of the foot and also aid in it’s inversion and eversion; the deep peroneal nerve that innervates them; and its blood supply comes from the anterior tibial artery and veins.

Since the fascia is not elastic it can’t stretch much. Therefore any increase of the cellular and extracellular volume or a decrease of the volume capacity, like with some external compression, will lead to the increase of the pressure inside the compartment.

This will compress the structures within, and the first ones to feel the effect of compression are the veins, because the pressure inside their lumen is normally low.

Summary

Compartment syndrome is when increased pressure within a closed space in the body (a compartment) causes decreased blood flow and can result in tissue damage. It usually occurs in the limbs after traumas and fractures, which causes swelling and bleeding within the compartment. Other causes can include severe burns, plaster casts, and surgery.

Symptoms of compartment syndrome include pain, tightness or numbness, loss of pulse in the extremity, and pallor or coolness of the skin. Diagnosis is made with a physical exam and measuring the pressure within the compartment. If not treated in time, it can lead to ischemia, then permanent damage and loss of the limb.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Acute Compartment Syndrome" Orthopedic Clinics of North America (2016)
  6. "The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome" The Open Orthopaedics Journal (2014)
  7. "Acute compartment syndrome of the limb" Trauma (2006)
  8. "Evaluation and Management of Acute Compartment Syndrome in the Emergency Department" The Journal of Emergency Medicine (2019)
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