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

    These factors increase your chance of developing ACS:
    • 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

    Symptoms may include:
    • 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 to two hours. In other cases, it may take days.
    ACS is an emergency. Get medical help right away. Damage can result in serious injury or even death.
  • Diagnosis

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

    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

    American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

    National Institutes of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

    CANADIAN RESOURCES

    Canadian Orthopaedic Foundation http://www.canorth.org

    Canadian Physiotherapy Association http://www.physiotherapy.ca

    References

    Basic metabolic panel. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/bmp/glance.html. 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 website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00204#Cause. 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. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/cbc/test.html. Updated June 25, 2012. Accessed October 24, 2012.

    Comprehensive metabolic panel. Lab Tests Online website. Available at: http://labtestsonline.org/understanding/analytes/cmp/glance.html. 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.

    Rorabeck CH, Macnab I. The pathophysiology of the anterior tibial compartmental syndrome.  Clin Orthop. 1975;52-57.

    Whitesides TE, Heckman MM. Acute compartment syndrome: Update on diagnosis and treatment. J Am Acad Orthop Surg. 1996;4:209-218.

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