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Acute Compartment Syndrome by Mary Cresse

Definition

When you have acute compartment syndrome (ACS), pressure builds up inside the enclosed spaces that hold muscles, nerves, and blood vessels. This prevents the muscles from getting oxygen. ACS can affect the arms, hands, legs, feet, and buttocks.

Compartment Syndrome in Lower Leg

Causes

Under the skin of the arms and legs are sheets of connective tissue called fascia. These wrap around groups of muscles, nerves, and blood vessels. They create a unit called a compartment. When pressure builds up in these enclosed spaces, it has nowhere to go. The pressure is redirected into the compartment. When pressure reaches a certain point, it disrupts blood flow. In ACS, trauma speeds up this process. Blood vessels may fail, and tissue dies.

Common causes include:

Traumatic injury (eg, from a car accident, sport injury, gunshot wound)
Fracture (linked to most cases)
Vein obstructions
Burns
Hemorrhage
Edema (swelling of tissues under skin)
Complication of surgery

Risk Factors

These factors increase your chance of developing ACS:

Pre-existing condition that could lead to fatal bleeding in cases of trauma, such as:
- Taking anticoagulants
- Having a bleeding disorder ( hemophilia )
Participation in certain sports (eg, football)
Bandages or casts that are worn too tightly or worn for too long
Recent injury to the area

Tell your doctor if you have any of these risk factors.

Symptoms

If you have any of these symptoms, do not assume it is due to ACS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Excruciating pain (but out of proportion to injury)
Feeling of tightness or fullness of muscles
Swollen, shiny skin over affected area
Sensation problems

Symptoms can develop within 30 minutes to two hours. In other cases, it may take days. ACS is an emergency. Get help right away. Damage can result in serious injury or even death.

Diagnosis

Your doctor will ask about your symptoms and medical history. She will also do a physical exam. Tests may include:

Tests to measure pressure inside the compartments (eg, slit catheter, tonometer)
Near-infrared spectroscopy (NIRS)—a test to measure the amount of oxygen in a tissue
MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
Reflex testing—to measure impairment
Range-of-motion testing
Other tests to identify what compartment is affected
Lab tests to determine the extent of damage, such as:
- Basic metabolic panel (BMP)—to assess the health of main body functions
- Comprehensive metabolic panel (CMP)—to evaluate organ functions
- Complete blood count (CBC)—to analyze the presence of various cells and substances found in the blood

Treatment

Surgery to relieve pressure, called fasciotomy, must be done right away to prevent permanent damage. The doctor makes a long slice into the fascia to open the envelope of tissue and relieve pressure.

Prevention

ACS is difficult to prevent because there are many causes. But there are some steps you can take to reduce your risk of injury, such as:

Wearing proper equipment when playing sports
Ensuring your medical records mention use of anticoagulants or blood diseases
Being aware of the risk of ACS when you are wearing a bandage or cast

RESOURCES:

American Academy of Orthopaedic Surgeons http://www.aaos.org/
National Institutes of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/

CANADIAN RESOURCES:

Canadian Orthopaedic Foundation http://www.canorth.org/
Physical Therapy Canada http://www.physicaltherapy.ca/

References:

Basic metabolic panel. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/bmp/glance.html . Updated September 2005. Accessed November 16, 2008.
Cascio B, Wilckens J, Ain M, Toulson C, Frassica F. Documentation of acute compartment syndrome at an academic health-care center. J Bone Joint Surg. 2005;87:346-350.
Christensen L. Compartment syndrome, acute. EBSCO Publishing Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=860 . Updated October 2007. Accessed November 9, 2008.
Compartment syndrome. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00204#Cause . Updated July 2007. Accessed November 20, 2008.
Compartment syndrome. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 2008. Accessed November 8, 2008.
Compartment syndrome: prevention. University of Maryland Medical Center website. Available at: http://www.umm.edu/ency/article/001224prv.htm . Accessed November 20, 2008.
Compartment syndrome: what it is, what to look out for and how it is treated. Sports Injury Bulletin website. Available at: http://www.sportsinjurybulletin.com/archive/compartment-syndrome.html . Accessed November 20, 2008.
Complete blood count. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/cbc/test.html . Accessed November 16, 2008.
Comprehensive metabolic panel. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/cmp/glance.html . Accessed November 16, 2008.
Huber L. Compartment syndrome, acute. EBSCO Publishing Rehabilitation Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16topicID=860 . Updated July 2008. Accessed November 10, 2008.
Stedman’s Medical Dictionary . 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005;417;700;1894-1895.
Rorabeck CH, Macnab I. The pathophysiology of the anterior tibial compartmental syndrome. Clin Orthop . 1975;52-57.
Whitesides TE, Heckman MM. Acute compartment syndrome: Update on diagnosis and treatment. J Am Acad Orthop Surg. 1996;4:209-218.

Last reviewed September 2009 by Rosalyn Carson-DeWitt, MD

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