Pressure The Pressure of Compartment Syndrome Kathleen Byington RN BSN MSN 621 Alverno College Spring, 2007

The Pressure Pressure of Compartment Syndrome

Kathleen Byington RN BSNMSN 621Alverno CollegeSpring, 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.

• Define Compartment Syndrome and where it can occur.

• Explain the Pathophysiology of Compartment Syndrome.

• Identify Signs and Symptoms.

• Explain treatment for Compartment Syndrome.

Objectives

Home PageDefinition

Diagnosis Quiz

PathophysiologyQuiz

Signs & SymptomsQuiz

TreatmentQuiz

Click on the sections

to advance to that section

or just use the arrows to advance.

DefinitionCompartment 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.

• A potentially limb-threatening complication, can be prevented if recognized and treated early.

(Merriam-Webster, 2005)

DefinitionIt 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


Diagnosis

CompartmentSyndrome

can be Acute

OrChronic

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)


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)


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 player’s 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 Falseor

Wrong

Try Again!!

Click on Question mark to return to question.

CorrectChronic 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 Falseor

Wrong

Try Again!!


CorrectCompartment syndrome

can occur in any limb or muscle compartment,

including the abdomen.

Click on triangle to go to Next Section.

Pathophysiology


Pathophysiology

Thick layers of tissue called fascia separate

groups of muscles in the arms and legs

from each other.(Health-care, 2005)


PathophysiologyInside 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)

PathophysiologyThe main compartments in the lower leg are:

Anterior compartment

Lateral compartment

Deep posterior compartment

Superficial posterior compartment.

Anterior

LateralDeep posterior

Superficial posterior

(NAON, 2004)(www.nettingimages.com

Image used with permission)

Pathophysiology

The Main compartments of the forearm are:

Superficial flexor

Deep Flexor

Extensor

Superficial flexor

Deep Flexor

Extensor

(NAON, 2004)

(www.nettingimages.comImage 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)


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

fasciaarteries

veins wires

Click on the your answer.

Wrong

Try Again!!


Correct

Fascia are the thick layers of tissue that separate groups of muscles in the arms and

legs from each other.


Quiz

The Fascia surrounding the compartment

are flexible and will expand with increase pressure?

True Falseor

Wrong

Try Again!!


CorrectThe fascia is NOT flexible,

that is why you have the increase in pressure

in the compartment.


QuizHow many compartments are there in

the lower extremities and forearm?

A

B

C

D

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 don’t remember, please link me back to the answer.

Click on the letter to answer.

Wrong

Try Again!!


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.

CorrectThe lower extremities have

4 compartmentsand

the forearm has 3 compartments


Signs & Symptoms


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)


Signs & Symptoms


• 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)


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)


Signs & Symptoms


• There may also be a tingling or burning sensation in the muscle.

• The muscle may feel tight or full.

(POSNA, 2005)


Signs & Symptoms


• 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.

This is a more invasive test used to determine the pressure in the compartment.

This test is not performed by nursing.

(Porth, 2005)


QuizChronic compartment syndrome

usually happensat the same time

during your workoutand

symptoms are relieved after rest.

True Falseor

Wrong

Try Again!!


CorrectChronic Compartment Syndrome

pain usually occurs at the same time during every workout, and goes away with rest and then reappears with activity again.


Quiz

What is the classic sign of Acute Compartment Syndrome?

A

B

C

D

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!!


Correct

All of the above are correct.


Treatment


Treatment


•Avoid doing activities that cause pain and swelling.

•Apply ice and elevating the limb slightly.

•Taking aspirin or ibuprofen to reduce inflammation.

(POSNA, 2005)


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)


TreatmentThe extremity should be kept at

heart level.

Elevation above the heart decreases local arterial perfusion and may further compromise

local blood flow. (NAON, 2004)


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)

TreatmentFasciotomy:

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!!


CorrectYou should NOT elevate

the extremity above the heart,

because it can decrease local arterial perfusion.


Quiz

Fasciotomy is the treatment for

Chronic Compartment Syndrome?

True or False

Wrong

Try Again!!


CorrectFasciotomy

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.


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-Webster’s 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 (7 th 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.

Documents

Pressure The Pressure of Compartment Syndrome Kathleen Byington RN BSN MSN 621 Alverno College Spring, 2007