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by Cresse M

Acute Compartment Syndrome

(ACS; Compartment Syndrome, Acute; Volkmann’s Ischemia)

Definition

Sheets of connective tissue called fascia are located under the skin of the arms and legs. These wrap around groups of muscles, nerves, and blood vessels to create a unit called a compartment. When pressure builds up in these enclosed spaces, it is redirected into the compartment. When pressure reaches a certain point, it disrupts blood flow. Blood vessels may fail and tissue dies. Acute compartment syndrome (ACS) can affect the arms, hands, legs, feet, and buttocks.
Compartment Syndrome in Lower Leg
Compartment Syndrome
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Causes

Common causes include:
  • Vein obstructions in the extremities
  • Hemorrhage
  • Complication of surgery

Risk Factors

Factors that may increase your chance of ACS include:
  • Pre-existing condition that could lead to fatal bleeding in cases of trauma, such as:
    • Taking anticoagulants
    • Having a bleeding disorder such as hemophilia
  • Participation in certain collision or contact sports such as football
  • Bandages or casts that are worn too tightly or worn for too long
  • Recent injury to the area
  • Burns
  • Swelling of tissues under the skin

Symptoms

ACS may cause:
  • Severe pain
  • Feeling of tightness or fullness of muscles
  • Swollen, pale, shiny skin over affected area
  • Numbness or tingling
Symptoms can develop within 30 minutes-2 hours. In other cases, it may take days.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids will be tested. This can be done with blood tests.
Imaging tests to evaluate bodily structures may include:
The pressure inside your compartments will be measured. This can be done with:
  • Slit catheter
  • Tonometer
  • Near-infrared spectroscopy

Treatment

ACS is a medical emergency. Call for emergency medical services right away. Damage can result in serious injury or even death.
Surgery to relieve pressure, called fasciotomy, must be done right away to prevent permanent damage. The doctor makes a long cut into the fascia to open the envelope of tissue and relieve pressure.

Prevention

ACS is difficult to prevent because there are many causes. But there are some steps you can take to reduce your risk of injury, such as:
  • Wearing proper equipment when playing sports
  • Making sure that your medical records mention if you have used anticoagulants or if you have blood diseases
  • Being aware of the risk of ACS when you are wearing a bandage or cast

RESOURCES

National Institutes of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Foundation
http://www.canorth.org
Canadian Physiotherapy Association
http://www.physiotherapy.ca

References

Basic metabolic panel. American Association for Clinical Chemistry Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/bmp/tab/glance. Updated September 6, 2012. Accessed November 25, 2013.
Cascio B, Wilckens J, et al. Documentation of acute compartment syndrome at an academic health-care center. J Bone Joint Surg. 2005;87:346-350.
Compartment syndrome. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00204. Updated October 2009. Accessed November 25, 2013.
Compartment syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 20, 2013. Accessed November 25, 2013.
Complete blood count. American Association for Clinical Chemistry Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/cbc/test.htm. Updated June 25, 2012. Accessed October 24, 2012.
Comprehensive metabolic panel. American Association for Clinical Chemistry Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/cmp/tab/glance. Updated September 6, 2012. Accessed November 25, 2013.
Erdos J, Dlaska C, et al. Acute compartment syndrome in children: a case series in 24 patients and review of the literature. Int Orthop. 2011 Apr;35(4):569-575.

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