Definition types management

1. 1

2. 2
“An elevation of interstitial pressurein a closed osteo-fascialcompartment that
results in microvascular compromise.”
 Itis a serious condition
 Requires emergency medical attention
The first medical referencewasin 1881, whenGerman doctor Richard von
Volkm`ann described a permanent contractureof theforearm related to ischemia
within muscle compartmentsof the arm
 Compartments– grouping of muscles, nerves and blood
vessels in the extremities.
 Inelastic fascia encases the compartments, protects the
tissues, and maintains tissue shape
ANATOMY
COMPARTMENT SYNDROME
FIRST DOCUMENT

3. 3
Lower Extremity Compartments – Calf
Anterior Lateral Deep Posterior Superficial
Posterior
MOST likely to be
affected
a) Tibialis
anterior
Extensor
muscles of
toes
b) Anterior Tibial
artery
c) Deep
peroneal
nerve
a. Peroneus
longusand
peroneus
brevis
b. superficial
peroneal
artery
a. Tibialis
posterior
b. flexor
digitorum
longus
c. flexor hallus
longus
a. Gastrocnemius
b. soleus muscle
c. Suralnerve
d. Lithotomy
positions

4. 4
Lower Extremity Compartments – Thigh

5. 5
Cross sectional anatomy of thigh

6. 6
Lower Extremity - Calf Lower Extremity –
Thigh
Upper Extremity
1. Deep PeronealNerve
 (most commonlyaffected) -
Anterior compartment.
 Sensoryterritoryis confined to
webspace between 1st and 2nd
toes and activates dorsiflexion
2. SuperficialPeronealNerve
 runsalong lateralcompartment
and supplies dorsum of the foot
(except 1st webspace)
3. PosteriorTibialNerve
 is within deep posterior
compartmentand provides
sensation to plantar surfaceof
the foot – motor function is
flexion of the toes
 FemoralNerve
 Anterior
Compartment
 Most commonly
affected
 Obturator Nerve
 Medial
Compartmentof
thigh
 Sciatic Nerve
 Posterior
Compartmentof
thigh
1. Radial Nerve
Back of the arm
and wraps around
to skin of forearms
and hands
2. Median Nerve
 Main nerves
of arm that
runsfull
length
 Axilla injury
3. UlnarNerve
• Extends
from cervical
collar
• 4th and 5th
digits
PHYSICAL ASSESSMENT

7. 7
Complications if not
treated
 Volkmann’scontracture
 Permanentsensory and
motor deficit
 Infection
 Chronic Pain
 Amputation
TISSUE SURVIVAL RATE

8. 8
Myoglobinuria after4 hours
 Renal failure
 Maintain a high urinaryoutput
 Alkalinize the urine
Celldeath initiates a “viciouscycle”
o increase capillary permeability
o increased muscle swelling
PATHOPHYSIOLOGY

9. 9
TYPES OF COMPARTMENT

10. 10
RISK FACTORS

11. 11
Pain that is out of proportion to the injury
• Pain with passive stretch of muscle
• Persistent deep ache or burning
• FIRSTpresenting symptom
DIAGNOSIS
PAIN
PRESSURE

12. 12
Often not utilized – proper equipmentrequired and user errorsare common
• >30-40 mmHg considered diagnostic
 A condition in which you feel sensation of numbnessor prickling
 Pins & Needles
 Early →contained to one compartment
 Late→ globally within limb
 Rarely present
 Often times, redness progressesto pallor
 Sign of vascular injury and quickly leads to ischemia
 LATE stage – emergent intervention require
 The existence of distal pulses DO NOT exclude compartmentsyndrome
 Check above and below area of concern
 Late stage – indicates progression
PARESTHESIA
PALLOR
PULSELESSNESS

13. 13
 Complete loss of muscle function for one or moremuscle groups
 Verylate finding→indicating nerve damage
DIFFERENTIALDIAGNOSIS
INVESTIGATION
 Full blood count
 Coagulation Profile
 X-ray/ultrasound
 Creatinine Phosphokinase
 Urine myoglobin
PARALYSIS
 Cellulitis
 DVTand
thrombophlebitis
 Gas Gangrene
 Necrotizing
fasciitis
 Peripheral
vascular injuries

14. 14
EVALUATION
1. Stryker Manometer
2. Mercurymanometer
3. Wick hand instrument
 Surgical(Should notbedelayed)
 Medical Management
 Physical therapyManagement
TREATMENT

15. 15
Medical Management
 ABC’s.
 Correcthypotension
 Remove circumferentialbandages& cast
 Limb at level of the heart
o moreelevation reduces the arterialinflow
 Supplementaloxygen administration
 With tight cast, compartmentalpressurefalls:
o 30% when cast is split on one side
o 65% when cast is split Bilaterally
o 75% with Splitting the inside padding
o 85 – 90% complete removal of cast
Surgical Management
Fasciotomy
 Skin and All compartments. Surgical incision
to the fascia to relieve tension or pressure.
 Complete opening of all fascial envelopes.
 The wound should be left open and
inspected 2 days later. If there is muscle
necrosis →debridement.
 If the tissues are healthy, the wound can be -
sutured (without tension) or - skin-grafted
or- allowed to heal by secondary intention

16. 16
 Clinical pictureequivocal
 Altered consciousness
 Multiple injuries
 Epiduralanesthesia
 Concomitantnerveinjury
 Children
Types
1. Singleincision
HIGH RISK

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2. Double incision
Late treatment
Early treatment

18. 18
Contra-indications to fasciotomy
 Confirmed acute compartmentsyndromediagnosisfor > 48 hours
o damagecannotbe reversed and
o significantinfection rate when dead tissue exposed
o Alreadydead muscles, as in crush injuries
EDUCATION:
 Wearing moreappropriatefootwear
 Choosing more appropriatesurfacesand terrain for exercise
 Pacing your activities
 Avoiding certain activities altogether
PT
MANAGEMENT
Stretching.
ROM
Muscle
Stengthenin
g
Manual
therapy
Education
Modalitie
s

19. 19
 Modifying your workplace to lower risk of injury
 PRICE(protection, rest, ice, compression, elevation)
Summary
 Compartmentsyndromeis a
clinical diagnosis
 should not be missed - disaster
 Requires urgenttreatment
 “Time” is the most important
factor to avoid irreversible
complications
 Do NOT applycircumferential
dressings