The Pressure of Compartment Syndrome Kathleen Byington RN

The Pressure of Compartment Syndrome Kathleen Byington RN BSN MSN 621 Alverno College Spring, 2007

How to use this Tutorial • Click on the right arrow to advance to the next slide. • Click on the left arrow to go to prior slide. • Click on the Home button to return to the home page.

Objectives • Define Compartment Syndrome and where it can occur. • Explain the Pathophysiology of Compartment Syndrome. • Identify Signs and Symptoms. • Explain treatment for Compartment Syndrome.

Home Page Definition Diagnosis Click on the sections to advance to that section or just use the arrows to advance. Quiz Pathophysiology Quiz Signs & Symptoms Quiz Treatment Quiz

Definition Compartment Syndrome • A painful condition resulting from the expansion or overgrowth of enclosed tissue (as of a leg muscle) within its anatomical enclosure (as a muscular sheath) producing pressure that interferes with circulation and adversely affects the function and health of the tissue itself. (Merriam-Webster, 2005) • A potentially limb-threatening complication, can be prevented if recognized and treated early.

Definition It can result from either internally expanding pressure forces or externally applied forces. • Internal pressure force causes increased compartment contents and can be caused from hemorrhage or edema. • External pressure causes decreased compartment size and can be caused by a splint, a cast or prolonged compression to an extremity. (NAON, 2001) Clip art derived from Microsoft Office.

Diagnosis Clip art derived from Microsoft Office.

Diagnosis Compartment Syndrome can be Acute Or Chronic

Diagnosis Chronic Compartment Syndrome • Muscle pain that repeatedly occurs with vigorous exercise and subsides with rest. • The pain worsens as exercise continues, ultimately restricting performance. • There will often be swelling and abnormal sensations in the affected limb during and immediately after exercise. (Sports Injury Bulletin, 2007) Clip art derived from Microsoft Office.

Diagnosis Chronic Compartment Syndrome • Can affect athletes of any age. Anyone involved in a lot of running or jumping. • Not exclusive to the lower leg. It can occur in the arm of a weightlifter, sport climber or motorcyclist, the forearm compartment is usually involved. (Sports Injury Bulletin, 2007) Clip art derived from Microsoft Office.

Diagnosis Acute Compartment Syndrome • Different from Chronic in that it does not require exertion of the muscle to incite pain, and the pain does not subside until treated. • It can affect any limb or muscle compartment, including the abdomen, but it mainly occurs after trauma to the lower leg. • It may take several hours for acute compartment syndrome to develop. (POSNA, 2005)

Diagnosis Acute Compartment Syndrome • It can by caused by a traumatic injury, such as a fracture of one of the long bones in the body. • A badly bruised muscle, as when a motorcycles falls on the leg of the rider or a football player receives a blow to the thigh from another player’s helmet. • A complication after surgery. • Blockage of circulation, such as from pressure over a blood vessel for too long while asleep. • A Crush injury to the foot. (POSNA, 2005) Clip art derived from Microsoft Office.

Quiz Chronic Compartment Syndrome may affect athletes of any age even adolescents? True or False

Wrong Try Again!! Click on Question mark to return to question.

Correct Chronic Compartment Syndrome can affect any athlete at any age. Click on star to go to Next Question

Quiz Compartment Syndrome can only occur in the legs? True or False

Wrong Try Again!! Click on Question mark to return to question.

Correct Compartment syndrome can occur in any limb or muscle compartment, including the abdomen. Click on triangle to go to Next Section.

Pathophysiology Clip art derived from Microsoft Office.

Pathophysiology Thick layers of tissue called fascia separate groups of muscles in the arms and legs from each other. (Health-care, 2005) Clip art derived from Microsoft Office.

Pathophysiology Inside each layer of fascia is a confined space, called a compartment, that includes the muscle tissue, nerves, and blood vessels. The compartment is surrounded by the fascia much like wires surrounded by insulation. (Health-care, 2005)

Pathophysiology There are four main compartments in the lower leg and three main compartments in the forearm. (NAON, 2004)

Pathophysiology Anterior Deep posterior Lateral The main compartments in the lower leg are: Anterior compartment Superficial posterior Lateral compartment Deep posterior compartment Superficial posterior compartment. (www. nettingimages. com Image used with permission) (NAON, 2004)

Pathophysiology Superficial flexor Extensor Deep Flexor The Main compartments of the forearm are: Superficial flexor Deep Flexor Extensor (NAON, 2004) (www. nettingimages. com Image used with permission)

Pathophysiology The Fascia surrounding the compartments in the arms and legs, do not expand, so any swelling in a compartment will lead to increased pressure in that compartment, which will compress the muscles, blood vessels, and nerves. (Health-care, 2005)

Pathophysiology As nerves in the compartment are compressed, sensory and motor function decrease and severe pain develops. (Health-care, 2005) Clip art derived from Microsoft Office.

Pathophysiology When the pressure in the compartments exceeds the capillary pressure of the tissues, perfusion stops and the tissues become ischemic. The ischemia causes fluid shifts and edema, adding to the pressure. (Health-care, 2005)

Pathophysiology If ischemia continues, muscle and nerve tissues die, causing permanent loss of function. (Health-care, 2005)

Pathophysiology Muscle damage will be irreversible after 4 -6 hours of ischemia. Nerve damage will be irreversible after 12 -24 hours. (NAON, 2004)

Quiz What separates the groups of muscles in the lower extremities and forearm? nerves fascia veins arteries Click on the your answer. wires

Wrong Try Again!! Click on Question mark to return to question.

Correct Fascia are thick layers of tissue that separate groups of muscles in the arms and legs from each other. Click on star to go to Next Question

Quiz The Fascia surrounding the compartment are flexible and will expand with increase pressure? True or False

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Correct The fascia is NOT flexible, that is why you have the increase in pressure in the compartment. Click on star to go to Next Question

Quiz How many compartments are there in the lower extremities and forearm? A The lower extremities have 6 compartments and the forearms have 12. B The lower extremities have 4 compartments and the forearms has 3 compartments. C Both have the same number, 3 compartments. D I don’t remember, please link me back to the answer. Click on the letter to answer.

Wrong Try Again!! Click on Question mark to return to question.

Pathophysiology There are four main compartments in the lower leg and three main compartments in the forearm. Click on the Star to return to the Question.

Correct The lower extremities have 4 compartments and the forearm has 3 compartments Click on triangle to go to Next Section.

Signs & Symptoms Clip art derived from Microsoft Office.

Signs & Symptoms Chronic Compartment Syndrome: • Onset of pain and a feeling of “fullness” over the involved compartments. • There may be a feeling of numbness in the legs/feet. • The affected area may feel tight and tense. (Felton, 2003) Clip art derived from Microsoft Office.

Signs & Symptoms Chronic Compartment Syndrome: • The symptoms occur at the same point of time during exercise. • Symptoms are relieved by rest, usually within 20 minutes of exercise, only to reappear with resuming exercise. (Felton, 2003) Clip art derived from Microsoft Office.

Signs & Symptoms Acute Compartment Syndrome: • Classic sign is PAIN. The pain may be intensely out of proportion to the injury, especially if no bone is broken. (POSNA, 2005) Clip art derived from Microsoft Office.

Signs & Symptoms Acute Compartment Syndrome: • There may also be a tingling or burning sensation in the muscle. • The muscle may feel tight or full. (POSNA, 2005) Clip art derived from Microsoft Office.

Signs & Symptoms Acute Compartment Syndrome: • If the area becomes numb or paralysis sets in, cell death has begun and efforts to lower the pressure in the compartment may not be successful in restoring function. (POSNA, 2005)

Signs & Symptoms Direct measurements of tissue pressure can be obtained using a needle or wick catheter inserted into the muscle compartment. Compartment decompression is recommended when pressures rise to 30 mm. Hg. (Porth, 2005) This is a more invasive test used to determine the pressure in the compartment. This test is not performed by nursing. Clip art derived from Microsoft Office.

Quiz Chronic compartment syndrome usually happens at the same time during your workout and symptoms are relieved after rest. True or False

Wrong Try Again!! Click on Question mark to return to question.

Correct Chronic Compartment Syndrome pain usually occurs at the same time during every workout, and goes away with rest and then reappears with activity again. Click on star to go to Next Question

Quiz What is the classic sign of Acute Compartment Syndrome? A Intense pain not proportional to the injury. B Tingling or burning sensation in the muscle. C The muscle may feel full and tense. D All of the Above.

Wrong Try Again!! Click on Question mark to return to question.

Correct All of the above are correct. Click on triangle to go to Next Section.

Treatment Clip art derived from Microsoft Office.

Treatment Chronic Compartment Syndrome: • Avoid doing activities that cause pain and swelling. • Apply ice and elevating the limb slightly. • Taking aspirin or ibuprofen to reduce inflammation. (POSNA, 2005) Clip art derived from Microsoft Office.

Treatment The Primary treatment for Acute compartment syndrome is to relieve the source of the pressure. Loosening an external constriction, such as removing a tight bandage or splitting a cast. (NAON, 2004) Clip art derived from Microsoft Office.

Treatment The extremity should be kept at heart level. Elevation above the heart decreases local arterial perfusion and may further compromise local blood flow. (NAON, 2004) Clip art derived from Microsoft Office.

Treatment If the relief of external pressure is not effective and the compartment pressures stay elevated or continue to rise, a fasciotomy may be necessary. (Porth, 2005)

Treatment Fasciotomy: During this procedure, the fascia is incised longitudinally and separated so that compartment volume can expand blood flow can be reestablished. Because of potential problems with wound infection and closure, this procedure is performed as a last resort. (Porth, 2005)

Treatment Early recognition is of utmost importance. Nurses need to maintain a high suspicion for compartment syndrome in order to identify it early and implement measures to prevent negative outcomes.

Quiz You should elevate the extremity above the heart if you think your patient has Acute Compartment Syndrome? True or False

Wrong Try Again!! Click on Question mark to return to question.

Correct You should NOT elevate the extremity above the heart, because it can decrease local arterial perfusion. Click on star to go to Next Question

Quiz Fasciotomy is the treatment for Chronic Compartment Syndrome? True or False

Wrong Try Again!! Click on Question mark to return to question.

Correct Fasciotomy is the last resort used for Acute Compartment Syndrome. Congratulations you have completed the tutorial. The references are on the next slide. Or you may return to the Home page. Clip art derived from Microsoft Office.

References: Felton, P. M. (2003) Chronic exertional compartment syndrome [Electronic Version] South Florida Institute of Sports Medicine. Retrieved March 23, 2007 from http: //www. southfloridasportsmedicine. com/education_pa_12. asp Friday, P (2007) Elseview, Inc. Images used with permission, Retrieved from www. nettingimages. com Health-Care (2007) What is compartment syndrome? Retrieved March 25, 2007 from http: //bone-muscle. health-cares. net/compartment-syndrome. php. Merriam-Webster (2005) Merriam-Webster’s Medical desk dictionary (revised edition) Springfield, Mass. Merriam-Webster Inc. NAON (2001) Core curriculum for orthopaedic nursing (4 th ed. ) Pittman, New Jersey. Anthony J. Jannetti, Inc. NAON (2004) An introduction to orthopaedic nursing (3 rd ed. ) Chicago, IL. National Association of Orthopaedic Nurses. Porth, C. M. (2005) Pathophysiology concepts of altered health states (7 th ed. ) Lippincott Williams and Wilkins. POSNA (2005) Compartment Syndrome [Electronic Version] American Academy of orthopaedic surgeons. Retrieved March 23, 2007 from http: //orthoinfor. aaos. org/fact/thr_report. cfm&topcategory=General Information&Thread_ID=287 Sports Injury Bulletin (2007) Compartment syndrome: what it is, what to look out for and how it is treated. Retrieved March 25, 2007 from http: //www. sportsinjurybulletin, com/archive/compartment-syndrome. html.