Compartment Syndrome

The Pressure of Compartment SyndromeKathleen Byington RN BSNMSN 621Alverno CollegeSpring, 2007

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ObjectivesDefine Compartment Syndrome and where it can occur.Explain the Pathophysiology of Compartment Syndrome.Identify Signs and Symptoms.Explain treatment for Compartment Syndrome.

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DefinitionDiagnosis QuizPathophysiologyQuizSigns & SymptomsQuizTreatmentQuizClick on the sectionsto advance to that sectionor just use the arrows to advance.

DefinitionCompartment SyndromeA painful condition resulting from the expansion or overgrowth of enclosed tissue (as of a leg muscle) within its anatomical enclosure (as a muscular sheath) producing pressure that interferes with circulation and adversely affects the function and health of the tissue itself.

A potentially limb-threatening complication, can be prevented if recognized and treated early.(Merriam-Webster, 2005)

DefinitionIt can result from either internally expanding pressure forces or externally applied forces.Internal pressure force causes increased compartment contents and can be caused from hemorrhage or edema.External pressure causes decreased compartment size and can be caused by a splint, a cast or prolonged compression to an extremity.

(NAON,2001)Clip art derived from Microsoft Office.

Diagnosis

Clip art derived from Microsoft Office.

Diagnosis

CompartmentSyndrome can be Acute OrChronic

Diagnosis

Chronic Compartment Syndrome Muscle pain that repeatedly occurs with vigorous exercise and subsides with rest.The pain worsens as exercise continues, ultimately restricting performance.There will often be swelling and abnormal sensations in the affected limb during and immediately after exercise.(Sports Injury Bulletin,2007)Clip art derived from Microsoft Office.

Diagnosis

Chronic Compartment Syndrome Can affect athletes of any age. Anyone involved in a lot of running or jumping.Not exclusive to the lower leg. It can occur in the arm of a weightlifter, sport climber or motorcyclist, the forearm compartment is usually involved.(Sports Injury Bulletin,2007)Clip art derived from Microsoft Office.

DiagnosisAcute Compartment SyndromeDifferent from Chronic in that it does not require exertion of the muscle to incite pain, and the pain does not subside until treated.It can affect any limb or muscle compartment, including the abdomen, but it mainly occurs after trauma to the lower leg.It may take several hours for acute compartment syndrome to develop.

(POSNA, 2005)

DiagnosisAcute Compartment SyndromeIt can by caused by a traumatic injury, such as a fracture of one of the long bones in the body.A badly bruised muscle, as when a motorcycles falls on the leg of the rider or a football player receives a blow to the thigh from another players helmet.A complication after surgery.Blockage of circulation, such as from pressure over a blood vessel for too long while asleep.A Crush injury to the foot.

(POSNA, 2005)Clip art derived from Microsoft Office.

QuizChronic Compartment Syndrome may affect athletes of any age even adolescents?TrueFalseor

WrongTry Again!!Click on Question mark to return to question.

CorrectChronic Compartment Syndrome can affect any athlete at any age. Click on star to go to Next Question

QuizCompartment Syndrome can only occur in the legs?TrueFalseor

CorrectCompartment syndrome can occur in any limb or muscle compartment, including the abdomen.Click on triangle to go to Next Section.

PathophysiologyClip art derived from Microsoft Office.

PathophysiologyThick layers of tissue called fascia separate groups of muscles in the arms and legs from each other.

(Health-care, 2005)Clip art derived from Microsoft Office.

PathophysiologyInside each layer of fascia is a confined space, called a compartment,that includes the muscle tissue, nerves, and blood vessels.

The compartment is surrounded by the fascia much like wires surrounded by insulation.(Health-care, 2005)

PathophysiologyThere are four main compartments in the lower leg and three main compartments in the forearm.(NAON, 2004)

PathophysiologyThe main compartments in the lower leg are:

Anterior compartment

Lateral compartment

Deep posterior compartment

Superficial posterior compartment.AnteriorLateralDeep posteriorSuperficial posterior(NAON, 2004)(www.nettingimages.comImage used with permission)

PathophysiologyThe Main compartments of the forearm are:

Superficial flexor

Deep Flexor

ExtensorSuperficial flexorDeep FlexorExtensor(NAON, 2004)(www.nettingimages.comImage used with permission)

PathophysiologyThe Fascia surrounding the compartments in the arms and legs, do not expand, so any swelling in a compartment will lead to increased pressure in that compartment, which will compress the muscles, blood vessels, and nerves.(Health-care, 2005)

PathophysiologyAs nerves in the compartment are compressed, sensory and motor function decrease and severe pain develops.

(Health-care, 2005)Clip art derived from Microsoft Office.

PathophysiologyWhen the pressure in the compartments exceeds the capillary pressure of the tissues, perfusion stops and the tissues become ischemic.

The ischemia causes fluid shifts and edema, adding to the pressure.(Health-care, 2005)

PathophysiologyIf ischemia continues, muscle and nerve tissues die, causing permanent loss of function.(Health-care, 2005)

PathophysiologyMuscle damage will be irreversible after 4-6 hours of ischemia.

Nerve damage will be irreversible after 12-24 hours.(NAON, 2004)

QuizWhat separates the groups of muscles in the lower extremities and forearm?nervesfasciaarteriesveinswiresClick on the your answer.

CorrectFascia are the thick layers of tissue that separate groups of muscles in the arms and legs from each other.Click on star to go to Next Question

QuizThe Fascia surrounding the compartmentare flexible and will expand with increase pressure?TrueFalseor

CorrectThe fascia is NOT flexible, that is why you have the increase in pressure in the compartment.Click on star to go to Next Question

QuizHow many compartments are there in the lower extremities and forearm?ABCDThe lower extremities have 6 compartments and the forearms have 12.The lower extremities have 4 compartments and the forearms has 3 compartments.Both have the same number, 3 compartments.I dont remember, please link me back to the answer.Click on the letter to answer.

PathophysiologyThere are four main compartments in the lower leg and three main compartments in the forearm.Click on the Star to return to the Question.

CorrectThe lower extremities have 4 compartmentsand the forearm has 3 compartmentsClick on triangle to go to Next Section.

Signs & SymptomsClip art derived from Microsoft Office.

Signs & SymptomsChronic Compartment Syndrome:

Onset of pain and a feeling of fullness over the involved compartments.

There may be a feeling of numbness in the legs/feet.

The affected area may feel tight and tense.

(Felton, 2003)Clip art derived from Microsoft Office.

Signs & SymptomsChronic Compartment Syndrome:The symptoms occur at the same point of time during exercise.

Symptoms are relieved by rest, usually within 20 minutes of exercise, only to reappear with resuming exercise.

(Felton, 2003)Clip art derived from Microsoft Office.

Signs & SymptomsAcute Compartment Syndrome:Classic sign is PAIN. The pain may be intensely out of proportion to the injury, especially if no bone is broken.(POSNA, 2005)Clip art derived from Microsoft Office.

Signs & SymptomsAcute Compartment Syndrome:There may also be a tingling or burning sensation in the muscle.The muscle may feel tight or full.

(POSNA, 2005)


Signs & SymptomsAcute Compartment Syndrome:

If the area becomes numb or paralysis sets in, cell death has begun and efforts to lower the pressure in the compartment may not be successful in restoring function.(POSNA, 2005)

Signs & SymptomsDirect measurements of tissue pressure can be obtained using a needle or wick catheter inserted into the muscle compartment.Compartment decompression is recommended when pressures rise to 30 mmHg.

This is a more invasive test used to determine the pressure in the compartment.

This test is not performed by nursing.(Porth, 2005)Clip art derived from Microsoft Office.

QuizChronic compartment syndrome usually happensat the same time during your workoutandsymptoms are relieved after rest.TrueFalseor

CorrectChronic Compartment Syndromepain usually occurs at the same time during every workout, and goes away with rest and then reappears with activity again.Click on star to go to Next Question

QuizWhat is the classic sign of Acute Compartment Syndrome?ABCDIntense pain not proportional to the injury. Tingling or burning sensation in the muscle.The muscle may feel full and tense.All of the Above.

CorrectAll of the above are correct.Click on triangle to go to Next Section.

TreatmentClip art derived from Microsoft Office.

TreatmentChronic Compartment Syndrome:

Avoid doing activities that cause pain and swelling.

Apply ice and elevating the limb slightly.

Taking aspirin or ibuprofen to reduce inflammation.(POSNA, 2005)


TreatmentThe Primary treatment for Acute compartment syndromeis to relieve the source of the pressure.

Loosening an external constriction, such as removing a tight bandage or splitting a cast.

(NAON, 2004)Clip art derived from Microsoft Office.

TreatmentThe extremity should be kept at heart level.

Elevation above the heart decreases local arterial perfusion and may further compromise local blood flow.

(NAON, 2004)Clip art derived from Microsoft Office.

TreatmentIf the relief of external pressure is not effective and the compartment pressures stay elevated or continue to rise, a fasciotomy may be necessary.(Porth, 2005)

TreatmentFasciotomy:During this procedure, the fascia is incised longitudinally and separated so that compartment volume can expand and blood flow can be reestablished.

Because of potential problems with wound infection and closure, this procedure is performed as a last resort.

(Porth, 2005)

TreatmentEarly recognition is of utmost importance.

Nurses need to maintain a high suspicion for compartment syndrome in order to identify it early and implement measures to prevent negative outcomes.

QuizYou should elevate the extremity above the heart if you think your patient has Acute Compartment Syndrome?TrueorFalse

CorrectYou should NOT elevate the extremity above the heart, because it can decrease local arterial perfusion.Click on star to go to Next Question

QuizFasciotomy is the treatment for Chronic Compartment Syndrome?TrueorFalse

CorrectFasciotomy is the last resort used for Acute Compartment Syndrome.

Congratulations you have completed the tutorial.The references are on the next slide.Or you may return to the Home page.Clip art derived from Microsoft Office.

References: Felton, P. M. (2003) Chronic exertional compartment syndrome [Electronic Version] South Florida Institute of Sports Medicine. Retrieved March 23, 2007 from http://www.southfloridasportsmedicine.com/education_pa_12.aspFriday, P (2007) Elseview, Inc. Images used with permission, Retrieved from www.nettingimages.comHealth-Care (2007) What is compartment syndrome? Retrieved March 25, 2007 from http://bone-muscle.health-cares.net/compartment-syndrome.php.Merriam-Webster (2005) Merriam-Websters Medical desk dictionary (revised edition) Springfield, Mass. Merriam-Webster Inc.NAON (2001) Core curriculum for orthopaedic nursing (4th ed.) Pittman, New Jersey. Anthony J. Jannetti, Inc.NAON (2004) An introduction to orthopaedic nursing (3rd ed.) Chicago, IL. National Association of Orthopaedic Nurses.Porth, C. M. (2005) Pathophysiology concepts of altered health states (7th ed.) Lippincott Williams and Wilkins.POSNA (2005) Compartment Syndrome [Electronic Version] American Academy of orthopaedic surgeons. Retrieved March 23, 2007 from http://orthoinfor.aaos.org/fact/thr_report.cfm&topcategory=General Information&Thread_ID=287 Sports Injury Bulletin (2007) Compartment syndrome: what it is, what to look out for and how it is treated. Retrieved March 25, 2007 from http://www.sportsinjurybulletin,com/archive/compartment-syndrome.html.

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Compartment Syndrome