Compartment syndrome is the compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body. This leads to tissue death from lack of oxygenation; the blood vessels being compressed by the raised pressure within the compartment. Compartment syndrome most often involves the forearm and lower leg.[1] It can be divided into acute, subacute, and chronic compartment syndrome.

Pathophysiology R

Any condition that results in an increase in compartment contents or reduction in a compartment’s volume can lead to the development of an acute compartment syndrome. When pressure is elevated, capillary blood flow is compromised. Edema of the soft tissue within the compartment further raises the intra-compartment pressure, which compromises venous and lymphatic drainage of the injured area. Pressure, if further increased in a reinforcing vicious circle, can compromise arteriole perfusion, leading to further tissue ischemia.

The normal mean interstitial tissue pressure is near zero in non-contracting muscle. If this pressure becomes elevated to 30 mmHg or more, small vessels in the tissue become compressed, which leads to reduced nutrient blood flow, ischemia and pain. Of particular importance is the difference between compartment pressure and diastolic blood pressure; where diastolic blood pressure exceeds compartment pressure by less than 30 mmHg it is considered an emergency.[citation needed]

Untreated compartment syndrome-mediated ischemia of the muscles and nerves leads to eventual irreversible damage and death of the tissues within the compartment.

Causes

Because the connective tissue that defines the compartment does not stretch, a small amount of bleeding into the compartment, or swelling of the muscles within the compartment, can cause the pressure to rise greatly. Common causes of compartment syndrome include tibial or forearm fractures, ischemic reperfusion following injury, hemorrhage, vascular puncture, intravenous drug injection, casts, prolonged limb compression, crush injuries and burns.[4][5] Another possible cause can be the use of creatine monohydrate; a history of creatine use has been linked to this condition.[6][7]

Compartment syndrome can also occur following surgery in the Lloyd Davis lithotomy position, where the patient's legs are elevated for prolonged periods. As of February 2001, any surgery that is expected to take longer than six hours to complete must include Compartment Syndrome on its list of post-operative complications. The Lloyd Davis lithotomy position can cause extra pressure on the calves and on the pneumatic pressure Flowtron boots worn by the patient.

When compartment syndrome is caused by repetitive use of the muscles, as in a cyclist, it is known as chronic compartment syndrome (CCS).[8][9] This is usually not an emergency, but the loss of circulation can cause temporary or permanent damage to nearby nerves and muscles.

Symptoms and signs

pain out of proportion to what is expected,

paresthesia,

pallor,

paralysis,

pulselessness;

6th P, for polar/poikilothermia (failure to thermoregulate)