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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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  • 729.71 Nontraumatic compartment syndrome of upper extremity
  • 958.91 Traumatic compartment syndrome of upper extremity

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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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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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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
  • Loss of sensation and 2-point discrimination deficits
  • Inability to use upper extremities
  • Fatigue

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Possible Contributing Causes

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  • Traumatic compartment syndrome
    • Car accident
    • Crush injury
    • Surgery
    • Complex fractures
      • Distal radius fracture
      • Ulnar fracture
      • Supracondylar ...

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