1 / 24

Compartment Syndrome

Compartment Syndrome. 2LT Larson 2LT Loomis 1LT Moravec. AGENDA. Introduction/Purpose Involved Anatomy Etiology Clinical Presentation and Dx Treatment/Intervention Conclusion. INTRODUCTION. Compartment Syndrome can be a life/limb threatening emergency

Download Presentation

Compartment Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Compartment Syndrome 2LT Larson 2LT Loomis 1LT Moravec

  2. AGENDA • Introduction/Purpose • Involved Anatomy • Etiology • Clinical Presentation and Dx • Treatment/Intervention • Conclusion

  3. INTRODUCTION • Compartment Syndrome can be a life/limb threatening emergency • Related to acute trauma or exertion • Affects the muscle tissue, innervation, and vascularization within a MS compartment • Has also been described in the foot, thigh, forearm and gluteal regions

  4. Types of CS • Acute Compartment Syndrome • Exertional Compartment Syndrome • Acute-one time episode • Chronic- with activity

  5. Under Pressure? • From Anatomy we all know the Crural Fascia is VERY tight and has a limited ability to expand • Increased compartmental pressure can result in ischemia, neuropraxia and if sustained, tissue NECROSIS

  6. Anterior Lateral COMPARTMENTS Deep Posterior Posterior

  7. Etiology • Acute CS: • Direct trauma = Fx or soft-tissue injury • More common in men (McQueen et al) • Initial injury leads to swelling within compartment • Muscle damage theorized to increases osmotic pressure from release of protein-bound ions

  8. Etiology • Exertional CS: • Overexertion- Associated with repetitive axial loading (runners and competitive skaters) • Muscle volume can increase up to 20% due to fiber swelling and blood filling from vigorous exercise

  9. Etiology • Chronic ECS (most commonly in Deep Compartment): No anatomical predisposition has been proven • Excessive compensatory pronation of the subtalor joint implicated • During gait this would increase activity of deep posterior compartment muscles • Usually bilateral involvement (50%-70%); one extremity usually more symptomatic

  10. CLINICAL PRESENTATION • Pnt c/o severe pain out of proportion to injury • Pain aggravated by passive muscle stretch • Loss of sensation may be useful sign • Dorsalis pedis pulse may or may not be affected http://www.physsportsmed.com

  11. CLINICAL PRESENTATION • Leg pain described as a dull ache (localized or diffuse) that begins at a predictable time during exercise • May also have: • Footdrop • Giving away of the ankle • Paraesthesias in the foot • Taut, shiny, warm skin that is TTP

  12. CLINICAL PRESENTATION • Post-exercise • Involved compartments are swollen and tense • Increased leg girth over involved muscles • Passive stretching of involved muscles may increase pain • Symptoms usually lessen within 30 min

  13. Differential Diagnosis • Rule out stress fractures or periostitis • Radiographs, bone-scan, bony tenderness • Medial tibial stress syndrome • pain and tenderness over soleus bridge • pain with exercise which can progress to other activities • pain increased by hyperpronation of the foot • Compression neuropathies- • electromyography

  14. Clinical Diagnosis • Intracompartmental pressure recordings (Taken pre/post exercise w/ slit catheter under local anesthesia) Pedowitz et al.

  15. Treating ECS • Conservative at first • Cross training with low impact activities (swimming, bicycling) • Rest, Ice, Elevation No Compression • NSAIDS • Stretching • Address biomechanical problems • Gradual return to activity

  16. Treatment Options • If symptoms persist with activity for > 3 to 6 months • A: Stop prevocational activities • B: Have Surgery: Fasciotomy of all involved compartments

  17. Surgical Outcome • Dependent upon compartment involvement • Results of anterior and lateral releases are superior to posterior release • Failure of Deep posterior compartment release largely due to insufficient release-as it is harder to get to • Management of fasciotomy wounds is controversial

  18. PT Intervention Post Surgery • Immediate Ice and Elevation • Crutches (TTWB) with gradual progression to FWB (1 week) • Gait training to prevent abnormal movement secondary to stiffness and guarding • ROM exercises to increase circulation: • ankle dorsiflexion, plantar flexion, inversion, eversion, alphabet exercise • knee flexion/ extension

  19. Rehab Progression • Gentle isokinetics • Stretching, of involved muscles • Aerobic training: Limited WB (swimming/cycling) • 4 weeks: • progression to running and resistive weight training as tolerated • 2-3 months full return to training

  20. Conclusion • Exercise induced ECS is often miss-diagnosed. • Awareness is key due to the dangers of untreated acute ECS. • Non-surgical interventions not shown to help long term. • Surgery is intervention for reliably high prognosis. • PT plays important role in Dx and post surgical Tx.

  21. QUESTIONS?

  22. REFERENCES • 1. Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. British Journal of Surgery. 2002; 89(4): 397-412. • 2. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?[comment]. Journal of Bone & Joint Surgery - British Volume. 2000;82(2):200-203. • 3. Pearse MF, Harry L, Nanchahal J. Acute compartment syndrome of the leg: fasciotomies must be performed early, but good surgical technique is important. British Medical Journal. 14 September 2002 2002;Volume 325(7364):557-558. • 4. Garcia-Mata S, Hidalgo-Ovejero A, Martinez-Grande M. Chronic exertional compartment syndrome of the legs in adolescents. Journal of Pediatric Orthopedics. 2001;21(3):328-334. • 5. Prentice WE, Voight MI. Techniques in musculoskeletal rehabilitation. New York: McGraw-Hill; 2001. • 6. Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? Journal of Orthopaedic Trauma. 2002;16(8):572-577. • 7. Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. Journal of Trauma-Injury Infection & Critical Care. 1996;40(3):342-344.

More Related