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Condition/Disorder Synonyms

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  • Chronic compartment syndrome (CCS)

  • Chronic exertional compartment syndrome (CECC)

  • Limb compartment syndrome

  • Myofascial compartment syndrome

  • Volar compartment syndrome of forearm (flexors)

  • Dorsal compartment syndrome of forearm (extensors)

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ICD-9-CM Codes1

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  • 729.71 Nontraumatic compartment syndrome of upper extremity

  • 958.91 Traumatic compartment syndrome of upper extremity

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ICD-10-CM Codes2

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  • M79.A1 Nontraumatic compartment syndrome of upper extremity

  • M62.2 Nontraumatic ischemic infarction of muscle

  • T79.6 Traumatic ischemia of muscle

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Preferred Practice Pattern3

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Key Features

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Description

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  • Bleeding or edema that leads to increased pressure within the fascial compartment and compromises circulation within that space, as well as the function of tissues in that area, causing ischemia

  • Arteriolar compression occurs and causes muscle and nerve ischemia

    • Acute, sensory changes develop after 30 minutes of ischemia

    • Acute, irreversible nerve damage in 12 to 24 hours

    • Acute, irreversible muscle changes (i.e., necrosis) in 3 to 8 hours

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Essentials of Diagnosis

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  • Diagnosis is typically made by clinical examination and compartment pressure measurement

  • Acute compartment syndrome

    • Medical emergency

    • Immediate surgery, fasciotomy

  • Subacute compartment syndrome

    • Less of an emergency, usually surgery, fasciotomy

  • Chronic exertional compartment syndrome

    • Conservative treatment first

    • Secondary surgery, fasciotomy

    • Begins after the start of exercise

    • Stops about 30 minutes following exercise

    • Symptoms can become progressively worse to constant

  • Severe pain that is not alleviated by elevation or pain medication

    • Pain increases with passive/active range of motion and compression

  • Distal pulses are diminished/absent

  • Strength and sensation are diminished

  • Edema in affected limb

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General Considerations

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  • Emergency surgery required to prevent permanent damage with 30 mm Hg or higher

  • Forearm has two compartments

    • Volar

    • Dorsal

  • Classic Ps

    • Pain

    • Pallor

    • Pulselessness

    • Paresthesias

    • Paralysis

  • Complications

    • Infection

    • Contractures

    • Deformity

    • Amputation

    • Acidosis

    • Hyperkalemia

    • Myoglobinuria

    • Acute renal failure and shock

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Demographics

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  • Younger age, high-energy/high-velocity trauma and systemic hypotension associated with increased risk of traumatic accident

  • High risk patients include

    • Males <35 years old with fractures

    • Soft tissue injury in males <35 years old with bleeding disorders or receiving anticoagulants

    • Crush injury patients

    • Patients with prolonged limb compression

  • Individuals using circumferential wraps, restrictive dressings, casts, or immobilizers are at increased risk

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Clinical Findings

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Signs and Symptoms

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  • First signs

    • Decreased sensation, numbness

    • Tingling, paresthesias

  • Paresis

  • Decreased palpable pulses

  • Pallor of skin overlying compartment, paleness of skin

  • Severe pain that does not go away with pain medicine or raising affected area

  • Weakness

  • Pain when the area is squeezed

  • Extreme pain when moving affected area

    • Deep, throbbing pressure out of proportion to that expected from the injury

  • Swelling in affected area

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Functional Implications

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  • Pain out of proportion to that expected from the injury

  • Decreased strength in affected limb

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