The classic findings associated with arterial insufficiency are often described as signs of ACS, but this is incorrect. Other symptoms include severe pain with passive movement of the muscles within the compartment, loss of voluntary movement of the muscles involved, and sensory changes and paresthesias in the area supplied by the involved nerve. Patients may present with pain out of proportion to the injury and swelling or tenseness in the area. The area in which symptoms occur and the type of complaints depend on which compartment is involved. The anterior compartment is most commonly involved, followed by the deep posterior compartment, then the lateral and superficial posterior leg compartments. With normal physical activity, muscle volume can increase up to 20%. The true incidence is unknown, as most people suffering from early symptoms will decrease or modify their activity without seeking out a healthcare professional. CECS is most commonly seen in runners, cyclists, and athletes in sports that demand running, jumping, and cutting, such as basketball and soccer. The risk of CECS is increased by anabolic steroids, which can induce muscle hypertrophy, thereby causing an increase in intracompartmental pressure and decreasing fascial elasticity. An increase in compartmental pressure interferes with blood flow, leading to ischemia and pain when the metabolic demands cannot be met. This has been coined chronic exertional compartment syndrome (CECS) and results from repetitive movements common in endurance sports. The overall incidence in complex pelvic surgeries may be as high as 1 in 500.Ĭhronic compartment syndrome occurs when the fascia in the lower leg does not accommodate to the increase in blood flow and fluid shifts that may occur with heavy exercise. Risk factors include the length of the procedure, the amount of leg elevation, the amount of perioperative blood loss, and the presence of peripheral vascular disease and obesity. This is known as “well leg compartment syndrome” and is most often seen after pelvic and perineal surgery. In patients with decreased mental status with prolonged limb compression, such as with alcohol or drug abuse, ACS can also develop from soft tissue injury and swelling.Īnother non-traumatic cause of compartment syndrome is ischemia leading to hyperperfusion, often caused by prolonged surgery in the lithotomy position. These include hemorrhage into a compartment, as can occur in anticoagulated patients, and compartment syndrome after diabetic muscle infarction. Non-traumatic causes of ACS are more rare. The anterior compartment is most commonly affected, although multiple compartments can be involved. ACS can occur in as many as 17% of tibial fractures. Direct pressure from a cast or antishock garment can increase the risk for compartment syndrome. ACS, most commonly occurring in males younger than 35 years, is most often caused by trauma such as fractures, crush injuries, muscle rupture, direct blow to a muscle, and circumferential burns. Untreated, ACS can progress to contractures, paralysis, infection, and gangrene in the limb as well as systemic problems, such as myoglobinuria and kidney failure. The focus of this chapter is compartment syndrome of the leg, although it can also affect the thighs or upper extremities.Īcute compartment syndrome (ACS) is a serious condition caused by a rapid rise in pressure in an enclosed space, which can lead to necrosis of the muscles and nerves in the involved compartment. Compartment syndrome can be either an acute or chronic condition caused by increased tissue pressure within an enclosed fascial space.
0 kommentar(er)
