219: COMPARTMENT SYNDROME, LOWER LEG

CONDITION/DISORDER SYNONYMS

• Chronic compartment syndrome (CCS)

• Chronic exertional compartment syndrome (CECC)

• Limb compartment syndrome

• Myofascial compartment syndrome

• Anterior compartment syndrome of the lower leg

• Lateral/peroneal compartment syndrome of the lower leg

• Deep posterior compartment syndrome of the lower leg

• Superficial posterior compartment syndrome of the lower leg

ICD-9-CM CODES¹

• 729.72 Nontraumatic compartment syndrome of lower extremity

• 958.92 Traumatic compartment syndrome of lower extremity

ICD-10-CM CODES²

• M62.2 Ischemic infarction of muscle (nontraumatic compartment syndrome)

• M79.A2 Nontraumatic compartment syndrome of lower extremity

• T79.6 Traumatic ischemia of muscle

PREFERRED PRACTICE PATTERN³

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

KEY FEATURES

Description

• Bleeding or edema 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 andnerve 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

Essentials of Diagnosis

• 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

General Considerations

• Require emergency surgery to prevent permanent damage with pressure measurements of 30 mm Hg or higher

• Lower leg has four compartments

  • Anterior

  • Lateral

  • Deep posterior

  • Superficial posterior

• Classic P’s

  • Pain

  • Pallor

  • Pulselessness

  • Paresthesias

  • Paralysis

• Complications

  • Infection

  • Contractures

  • Deformity

  • Amputation

  • Acidosis

  • Hyperkalemia

  • Myoglobinuria

  • Acute renal failure and shock