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Compartment Syndrome

Conditions in which increased pressure within a limited space compromises the blood circulation and function of tissue within that space. Some of the causes of increased pressure are trauma, tight dressings, hemorrhage, and exercise.

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(Source: NIH - National Library of Medicine)

About Compartment Syndrome

In many parts of the body, muscles (along with the nerves and blood vessels that run alongside and through them) are enclosed in a "compartment" formed of a tough membrane called fascia. When muscles become swollen, they can fill the compartment to capacity, causing interference with nerves and blood vessels as well as damage to the muscles themselves. The resulting painful condition is referred to as compartment syndrome.

Compartment syndrome may be caused by a one-time traumatic injury (acute compartment syndrome), such as a fractured bone or a hard blow to the thigh, by repeated hard blows (depending upon the sport), or by ongoing overuse (chronic exertional compartment syndrome), which may occur, for example, in long-distance running. NIH - National Institute of Arthritis and Musculoskeletal and Skin Diseases

What works? Research summarized

Evidence reviews

Fasciotomy wounds associated with acute compartment syndrome: a systematic review of effective treatment

Bibliographic details: Walker M, Kralik D, Porritt K.  Fasciotomy wounds associated with acute compartment syndrome: a systematic review of effective treatment. JBI Database of Systematic Reviews and Implementation Reports 2014; 12(1): 101-175 Available from: http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/1064

Decompressive laparotomy for abdominal compartment syndrome: a critical analysis

INTRODUCTION: Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented. Surgical decompression through a midline laparotomy or decompressive laparotomy remains the sole definite therapy for ACS, but the effect of decompressive laparotomy has not been studied in large patient series.

Acute traumatic compartment syndrome: a systematic review of results of fasciotomy

This review assessed diagnosis and treatment of acute compartment syndrome with fasciotomy and concluded that mortality and morbidity outcomes were better if fasciotomies are performed within six hours of the onset of symptoms. The review question was unclear and most aspects of the review process were poorly reported and as a result the reliability of the conclusion is uncertain.

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Summaries for consumers

Surgical interventions for treating distal humeral fractures in adults

The distal humerus is the end of the upper arm bone (the humerus) and forms the upper part of the elbow joint. Its structure is highly complex as it connects with both forearm bones (the radius and ulna) to allow a wide range of motion: in bending and straightening out of the elbow, and rotating of the forearm. Fractures to the distal humerus most often occur in young men from high‐energy trauma; or older women, aged 60 years and over, who typically have osteoporosis and whose fracture results from a low‐energy fall. Most distal humeral fractures need surgical intervention because elbow motion is either very difficult or impossible. Open reduction and internal fixation, to hold the bone fragments in place until the bone is healed, with various plates and fixation techniques is the standard surgical treatment, especially in younger patients. Total elbow replacement or arthroplasty is where the distal humerus and ulna bone ends forming the elbow are replaced by an artificial joint. Imposed lifting restrictions, irrespective of age, are necessary for successful total elbow arthoplasty.

Treatment for meralgia paraesthetica, a condition causing numbness and sometimes pain in the thigh

Meralgia paraesthetica is a common clinical condition caused by damage to the lateral cutaneous nerve of the thigh, resulting in pain, numbness and tingling in the front and outer side of the thigh. The diagnosis is easy to make clinically. Although not life‐threatening, the condition can cause a lot of discomfort to the affected individual. A number of interventions are in common use and we wanted to examine the evidence in the literature for their efficacy. We found no randomised controlled trials (RCTs) in the original review or when searches were updated in 2010 and 2012. Local injections of corticosteroid and surgical operations were found to be effective treatments in observational studies. However, a single observational study also showed that meralgia paraesthetica improved spontaneously in the majority of cases. RCTs of treatments for meralgia paraesthetica are needed.

Treatment for ulnar neuropathy at the elbow

Ulnar neuropathy at the elbow is the second most common form of nerve irritation from a trapped or compressed nerve, after carpal tunnel syndrome. People with the condition normally have tingling of the fourth and fifth finger at night, pain at the elbow, and altered sensation on prolonged bending of the elbow. In severe cases the condition causes weakness in the muscles of the hand, which is innervated by the ulnar nerve. Diagnosis is based on signs, symptoms, and nerve conduction studies. The treatment of ulnar neuropathy at the elbow can be conservative (splint devices, physical therapy, rehabilitation) or surgical. We found one randomised controlled trial (RCT) of conservative treatment involving 51 participants, which supports the opinion that conservative treatment is effective in clinically mild or moderate ulnar neuropathy. In this study, provision of written information on avoiding movements or positions provoking the symptoms, either alone, combined with night splinting for three months, or combined with nerve gliding exercises, was equally effective in improving occupational activities and reducing pain at night. None of the conservative treatments improved muscle strength. In three RCTs, a total of 131 participants were treated by the surgical technique of simple decompression and 130 participants were treated by transposition of the nerve (submuscular or subcutaneous transposition). Meta‐analysis found no significant difference between simple decompression and transposition of the ulnar nerve (subcutaneous or submuscular) in postoperative clinical and neurophysiological improvement. In another trial (47 participants) the authors compared medial epicondylectomy with anterior transposition and found no difference in clinical and neurophysiological outcomes. The available evidence is not sufficient to identify the best treatment of ulnar neuropathy at the elbow, on the basis of clinical, neurophysiological and imaging characteristics. However, in mild cases information on movements and positions to avoid may reduce subjective discomfort. Moreover, the results of our meta‐analysis suggest that simple decompression surgery and decompression with transposition are equally effective. Decompression with transposition results in a higher number of deep and superficial wound infections.

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More about Compartment Syndrome

Photo of a young adult

Other terms to know:
Fascia, Fasciotomy, Hemorrhage

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