Compartment Syndrome

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Compartment syndrome is a serious condition that occurs when there is increased pressure within a closed muscle compartment, leading to compromised blood flow and tissue perfusion. This can result in muscle and nerve damage.

Aetiology

Compartment syndrome can be caused by:

• Trauma, such as fractures, crush injuries, or severe bruising
• Burns or snake bites
• Prolonged limb compression
• Vigorous exercise
• Post-surgical complications

Pathophysiology

The pathophysiology of compartment syndrome involves:

• Increase in pressure within a closed fascial compartment
• Compromised blood flow and oxygen supply to muscles and nerves
• Ischaemia leading to cell death and muscle necrosis
• Inflammation and further increase in compartment pressure

Risk Factors

• High-impact trauma
• Fractures, particularly of the tibia or forearm
• Burn injuries
• Vigorous physical activity
• Anticoagulant therapy

Signs and Symptoms

The signs and symptoms of compartment syndrome include:

• Severe pain, especially with muscle stretching
• Swelling and tightness in the affected area
• Paresthesia (tingling or burning sensation)
• Pallor (pale skin)
• Paralysis or muscle weakness
• Absence of distal pulses (late sign)

Investigations

Specific investigations to diagnose compartment syndrome include:

• Clinical examination: Assess for pain, swelling, and neurological deficits.
• Intracompartmental pressure measurement: Direct measurement of compartment pressure using a manometer.
• Imaging studies:
  • Ultrasound: To assess for muscle oedema or haematoma.
  • MRI: To evaluate soft tissue damage and compartment pressure indirectly.
• Blood tests: To check for signs of rhabdomyolysis, including elevated creatine kinase (CK) levels.

Management

Primary Care Management

• Initial assessment: Early recognition and prompt referral to emergency services.
• Remove constrictive dressings or casts: To alleviate external pressure.
• Elevate the affected limb: To reduce swelling (avoid elevation above heart level if it increases pain).

Specialist Management

• Emergency fasciotomy: Surgical decompression of the compartment to relieve pressure.
• Supportive care: Including pain management, hydration, and monitoring for complications such as acute kidney injury.
• Postoperative care: Regular monitoring for infection, wound care, and physiotherapy to restore function.

References

1. NHS (2024) Compartment Syndrome. Available at: https://www.nhs.uk/conditions/compartment-syndrome/ (Accessed: 24 June 2024).
2. British Orthopaedic Association (2024) BOAST - Diagnosis and Management of Compartment Syndrome. Available at: https://www.boa.ac.uk/resources/boast-diagnosis-and-management-of-compartment-syndrome.html (Accessed: 24 June 2024).
3. British Medical Journal (2024) Compartment syndrome: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h4367 (Accessed: 24 June 2024).
4. Mubarak, S.J., and Hargens, A.R. (1983) 'Compartment Syndromes and Volkmann's Contracture', WB Saunders, Philadelphia.

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