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PubMedDate not supplied

The tibialis posterior muscle compartment. An unrecognized cause of exertional compartment syndrome.

Exertional compartment syndrome in the deep posterior compartment of the leg is well recognized. This paper reports investigations which were performed to prove that the tibialis posterior muscle is contained in its own osseofascial compartment, separate from the rest of the deep posterior compartment. Radiographs following the injection of radio-opaque dye into the tibialis posterior muscle demonstrated the fluid-impermeable, osseofascial boundaries surrounding this muscle. Compartment syndromes created in cadaver legs reveal that traditional techniques of fasciotomy of the deep posterior compartment are inadequate in decompressing the tibialis posterior muscle. Intracompartmental pressure measurements in athletes with a clinical diagnosis of exertional compartment syndrome proved the existence of isolated exertional compartment syndrome in the tibialis posterior muscle. From these results we may conclude that the tibialis posterior muscle is contained in a separate osseofascial muscle compartment which may be the site of an isolated exertional compartment syndrome and that common techniques of fasciotomy of the deep posterior compartment do not decompress the tibialis posterior muscle.

Adult↗
PubMed2005

[Systemic capillary leak syndrome causes a compartment syndrome of both lower legs and a forearm. A case report with a review of the literature].

Systemic capillary leak syndrome is a rare disorder which causes recurrent episodes of hypovolemic shock due to a markedly increased plasma shift into the interstitium. Hemoconcentration, hypoalbuminemia and a monoclonal gammopathy are characteristic laboratory findings. A rare manifestation of this disease is a compartment syndrome with rhabdomyolysis and acute renal failure. We describe a patient who suffers from a compartment syndrome of both lower legs and the left forearm secondary to systemic capillary leak syndrome, and discuss the pathophysiological background.

Capillary Leak Syndrome↗
PubMed2004

Differences in attitudes to analgesia in post-operative limb surgery put patients at risk of compartment syndrome.

Missed compartment syndrome may result in severe disability. Complete masking of pain, the cardinal symptom of compartment syndrome, may contribute to delayed or missed diagnosis. Scenarios reported in the literature as cases of delayed or missed compartment syndrome (due to analgesia) were included in a questionnaire. Each of the respondents was requested to indicate the preferred choice of post-operative analgesia for each scenario. Significant differences were found between orthopaedic surgeons and anaesthetists regarding the preferred choice of post-operative analgesia in clinical situations which have been previously shown to be associated with a high risk of compartment syndrome. Use of analgesic methods which impair the ability to detect patients with abnormal levels of pain or unusual demands for analgesia may place such patients at risk of the devastating sequelae of a missed compartment syndrome. The differences in attitudes to local and regional nerve blockade between orthopaedic surgeons and anaesthetists suggests that some anaesthetists may be exposing patients to the risk of missed compartment syndrome following extremity surgery.

Analgesia↗
PubMed2003

Pathophysiology and management of abdominal compartment syndrome.

Abdominal compartment syndrome is a potentially lethal condition caused by any event that produces intra-abdominal hypertension; the most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Hemodynamic, respiratory, renal, and neurological abnormalities are hallmarks of abdominal compartment syndrome. Medical management consists of urgent decompressive laparotomy. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.

Abdomen↗
PubMed1994

[Instrumental muscle pressure measurement in acute and chronic compartment syndrome].

Acute compartment syndrome is a serious complication of trauma to the extremities. Increases in intra-compartmental tissue pressure result from increases in fluid pressure. The indication for a fasciotomy in impending compartment syndrome depends on the tissue pressure. To facilitate the diagnosis of high intramuscular pressure in acute and chronic compartment syndrome, we have developed a pressure monitor that enables us to measure pressure simply and exactly. The pressure monitor has a very low drift, high accuracy and linearity, and is easy to handle. The clinical application of the pressure monitor proved to be a useful tool in the management of an injured limb. This article reviews the pathophysiology and mechanism of acute and chronic compartment syndrome as well as the intracompartmental pressure monitoring.

Compartment Syndromes↗
PubMed1997

Bilateral gluteal compartment syndrome.

Gluteal compartment syndrome is uncommon but potentially devastating. Bilateral gluteal compartment syndrome occurs far more infrequently, with only three previous cases reported to date. This report reviews a case of bilateral gluteal compartment syndrome, the relevant anatomy of the gluteal region, and the etiology, pathophysiology, diagnosis, and treatment of this phenomenon.

Adult↗
PubMed1991

Acute lower leg compartment syndrome.

Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of acute compartment syndromes are discussed. Early recognition and treatment are important in the prevention of long-term disability.

Acute Disease↗
PubMed1989

Compartment syndromes.

The compartment syndrome is defined as a condition in which high pressure within a closed fascial space (muscle compartment) reduces capillary blood perfusion below the level necessary for tissue viability'. This condition occurs in acute and chronic (exertional) forms, and may be secondary to a variety of causes. The end-result of an extended period of elevated intramuscular pressure may be the development of irreversible tissue injury and Volkmann's contracture. The goal of treatment of the compartment syndrome is the reduction of intracompartmental pressure thus facilitating reperfusion of ischaemic tissue and this goal may be achieved by decompressive fasciotomy. Controversy exists regarding the critical pressure-time thresholds for surgical decompression and the optimal diagnostic methods of measuring intracompartmental pressures. This paper will update and review some current knowledge regarding the pathophysiology, aetiology, diagnosis, and treatment of the acute compartment syndrome.

Capillaries↗
PubMed1998

Acute compartment syndrome.

Acute compartment syndrome is a serious complication of injury. It occurs when raised pressure within a closed osteofascial compartment compromises the circulation and function of tissues within the compartment. Most cases are caused by fracture. The largest group are tibial diaphyseal fractures, followed by soft tissue injury, crush syndrome, distal radial fractures and forearm diaphyseal fractures. Those at risk of developing acute compartment syndrome are young males, patients with bleeding disorders or on anticoagulant therapy and in the upper limb, high energy injury. The clinical symptoms and signs of acute compartment syndrome are pain, stretch pain and neurological abnormality, none of which are constantly present. Since early diagnosis of this condition is of paramount importance compartment monitoring is recommended. The recommended tissue pressure threshold for decompression has been variable through the years but should be related to the patient's blood pressure. A difference of less than 30 mmHg between the diastolic and tissue pressures has been validated clinically and it is recommended that at this level serious consideration should be given to decompression of the affected compartments. Use of this pressure threshold with compartment monitoring has been shown to half the delay to fasciotomy and significantly reduces the late complications of acute compartment syndrome.

Acute Disease↗
PubMed2006

Systemic capillary leak syndrome associated with compartment syndrome and rhabdomyolysis.

Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by recurrent spontaneous episodes of hypovolaemic shock due to marked plasma shifts from the intravascular to the extravascular space. This presents as the characteristic triad of hypotension, haemoconcentration and hypoalbuminemia often with an associated monoclonal gammopathy. We describe a patient with SCLS who required aggressive fluid resuscitation and emergency fasciotomies for compartment syndrome with rhabdomyolysis. At presentation the patient was considered to have severe erythrocytosis and was therefore initially referred to a haematologist, which appears to be a frequent sequence of presentation for patients with SCLS. This patient also highlights the importance of muscle compartment pressure monitoring during volume resuscitation in patients with SCLS.

Acute Kidney Injury↗
PubMed1994

Gluteal compartment syndrome.

Gluteal compartment syndrome is a rare disorder that most often occurs in conjunction with prolonged immobility after a sedative overdose but also may result from direct trauma. Patients present with localized tenderness, induration, and pain with passive flexion of the gluteal muscles. Signs of sciatic nerve compression occur frequently, and rhabdomyolysis may be associated with the syndrome. If the diagnosis of gluteal compartment syndrome is suspected, intracompartmental pressures should be measured. If pressures are high or if sufficient clinical suspicion remains, the patient should undergo prompt fasciotomy.

Adult↗
PubMedDate not supplied

Current concepts in pathophysiology and diagnosis of compartment syndromes.

A compartment syndrome is a neurovascular compromise resulting from an increased local tissue pressure. Compartment syndromes can have many etiologies and may arise in any area of the body that has little or no capacity for tissue expansion. The sequelae are severe in the absence of immediate diagnosis and treatment. The diagnosis is usually a clinical one but compartment pressure measurements are often helpful. Many methods of treatment have been investigated, but definitive treatment consists of immediate removal of the constricting force, most often accomplished with surgical fasciotomy.

Compartment Syndromes↗
PubMed2001

Orthopedic pitfalls in the ED: acute compartment syndrome.

Acute compartment syndrome is a rare but potentially disastrous complication of orthopedic injury to the extremities. Compartment syndrome occurs when the circulation and function of muscle within a closed fascial space are compromised by increased pressure within that space. Early diagnosis and treatment is crucial to prevent the devastating complications of this condition. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Adult↗
PubMed1995

Abdominal compartment syndrome.

Abdominal compartment syndrome is still a controversial entity. We report on a patient who developed the classical hemodynamic, respiratory, and renal changes of abdominal compartment syndrome after surgical intervention for blunt abdominal trauma. A decompressive laparotomy improved the situation dramatically.

Abdominal Injuries↗
PubMed2000

[Rare, but severe complication of varicose vein surgery. Compartment syndrome].

The compartment syndrome is an extremely rare complication after varicose vein surgery. If the early symptoms are not recognized and a treatment is not performed immediately most patients lose sensomotory function. Three cases with compartment syndrome after varicose vein stripping were the reason to point out the anatomy and pathophysiology of this complication and to explain the surgical technique.

Adult↗
PubMedDate not supplied

Chronic exertional compartment syndrome: the controversial "fifth" compartment of the leg.

BACKGROUND: The existence of a "fifth" compartment in the leg capable of developing distinct chronic exertional compartment syndrome remains a subject of controversy. HYPOTHESIS: Specific pressure recordings and dissection will confirm or disprove the existence of a fifth compartment. STUDY DESIGN: Empirical anatomic study. METHODS: Radiopaque dye was injected directly into the tibialis posterior muscle of 25 embalmed cadaveric legs while intracompartmental pressure was monitored. Radiographs demonstrated dye distribution, and dissection-documented fascial and epimysial layers. RESULTS: Evidence was found that the fibular origin of the flexor digitorum longus muscle, when present, could create subcompartments within the deep posterior compartment. The nature of this attachment varied from being absent, to small (<8 cm), to extensive (>8 cm). The attachment partially covered the tibialis posterior muscle in the majority of the 14 legs that developed high pressures, and it was limited or absent in the 11 legs that did not. Radiographs demonstrated that the dye was confined to the tibialis posterior muscle in four legs. CONCLUSIONS: No consistent fifth compartment exists in the leg; however, subcompartments within the deep posterior compartment created by the fibular origin of the flexor digitorum longus muscle may develop pressures congruent with chronic exertional compartment syndrome. CLINICAL RELEVANCE: Potential deep posterior subcompartments demand accurate pressure investigation. A modified technique to decompress the entire deep posterior compartment, including the tibialis posterior muscle, is necessary for successful treatment of chronic exertional compartment syndrome.

Aged↗
PubMed2024

Proteomics analysis of deep fascia in acute compartment syndrome.

Acute compartment syndrome (ACS) is a syndrome in which local circulation is affected due to increased pressure within the compartment. We previously found in patients with calf fractures, the pressure of fascial compartment could be sharply reduced upon the appearance of tension blisters. Deep fascia, as the important structure for compartment, might play key role in this process. Therefore, the aim of the present study was to examine the differences in gene profile in deep fascia tissue in fracture patients of the calf with or without tension blisters, and to explore the role of fascia in pressure improvement in ACS. Patients with lower leg fracture were enrolled and divided into control group (CON group, n = 10) without tension blister, and tension blister group (TB group, n = 10). Deep fascia tissues were collected and LC-MS/MS label-free quantitative proteomics were performed. Genes involved in fascia structure and fibroblast function were further validated by Western blot. The differentially expressed proteins were found to be mainly enriched in pathways related to protein synthesis and processing, stress fiber assembly, cell-substrate adhesion, leukocyte mediated cytotoxicity, and cellular response to stress. Compared with the CON group, the expression of Peroxidasin homolog (PXDN), which promotes the function of fibroblasts, and Leukocyte differentiation antigen 74 (CD74), which enhances the proliferation of fibroblasts, were significantly upregulated (p all <0.05), while the expression of Matrix metalloproteinase-9 (MMP9), which is involved in collagen hydrolysis, and Neutrophil elastase (ELANE), which is involved in elastin hydrolysis, were significantly reduced in the TB group (p all <0.05), indicating fascia tissue underwent microenvironment reconstruction during ACS. In summary, the ACS accompanied by blisters is associated with the enhanced function and proliferation of fibroblasts and reduced hydrolysis of collagen and elastin. The adaptive alterations in the stiffness and elasticity of the deep fascia might be crucial for pressure release of ACS.

Humans↗