You are on page 1of 66

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 players 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 the 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

Wrong
Try Again!!

Click on Question mark to return to question.

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.

The lower extremities have 4 compartments


and the forearms has 3 compartments.

Both have the same number, 3 compartments.

I dont 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 mmHg. (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.

Tingling or burning sensation in the muscle.

The muscle may feel full and tense.

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 and 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-Websters Medical desk dictionary (revised edition)
Springfield, Mass. Merriam-Webster Inc.
NAON (2001) Core curriculum for orthopaedic nursing (4th ed.) Pittman, New Jersey.
Anthony J. Jannetti, Inc.
NAON (2004) An introduction to orthopaedic nursing (3rd ed.) Chicago, IL. National
Association of Orthopaedic Nurses.
Porth, C. M. (2005) Pathophysiology concepts of altered health states (7th 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.