The Topic of Compartment Syndrome - Essay Example

The term Compartment Syndrome, when encountered for the first time may seem like a difficult concept to understand. Even with the bulk of the medical dictionaries, encyclopedias and even internet articles citing medical phrases and jargon, only a select few could understand, thus, it is no wonder that the bulk of the population scratch their heads in confusion when faced with such medical terms. The purpose of this paper therefore is to present the topic of Compartment Syndrome in the clearest and simplest way possible while maintaining to be concise. That way, the term may be understood by readers who have little or no medical background at all. Any medical phrases seen or read in this paper will be explained and discussed to the fullest as to not confuse anyone. In Focus: Compartment Syndrome As the name implies, Compartment Syndrome has a lot to do with “compartments.” Compartment syndrome is a painful condition that results when pressure within the muscles builds to dangerous levels. This prevents nourishment from reaching nerve and muscle cells. Muscle groups in the arms, hands, legs, feet, and buttocks can be affected. Within these muscle groups are nerves and blood vessels. The muscle groups are covered by tough membrane (fascia), which does not readily expand. The whole unit is called a compartment (University of Maryland Medical Center, 2007). These compartments are located within thick layers of connective tissue called fascia, which separates group of muscles in the arms and legs from each other (University of Maryland Medical Center, 2007). Within the enclosed spaces of the fascia, muscles, blood vessels and nerves are found and bundled together. For clearer metaphor, just think of wires surrounded by insulation, in this case, the fascia surrounding, muscles, blood vessels and the nerves. The fascia has limited flexibility. Unlike a balloon, the fascia does not expand. So, if any inflammation or swelling occurs within the compartments, pressure will increase and compress the muscles, blood vessels and nerves inside. If the pressure is high enough, blood flow to the compartment will be blocked which can lead to permanent damage to the muscles and nerves. If the pressure and absence of circulation lasts long enough, the limb may die and may need to be amputated (University of Maryland Medical Center, 2007). The swelling that may lead to Compartment Syndrome most frequently occurs either in the upper or lower extremities of the body, which are the arms and legs. Compartment Syndrome of the upper extremity is rare, but happens frequently. It most often affects the forearm, while compartment syndrome of the upper arm and the hand are seen much more seldom. Compartment syndrome in the lower extremity however, may occur around the pelvis, in the thigh, the lower leg or the foot. Now and then, combined compartment syndrome of the neighboring skeletal regions may be observed. If pressure within the compartment gets too high (for example, from too much swelling or bleeding after surgery or injury), the lack of oxygen to the tissue can damage blood vessels and nerve and muscle cells permanently (Hessmann, Ingelfinger & Rommens, 2007). Swelling leading to Compartment Syndrome may be acute or chronic. Acute Chronic Compartment Syndrome (ACS) is associated with high energy trauma such as from a car accident or crush injury, or maybe even surgery. It may also occur due to tight bandages or casts; with significant swelling pressure will build up and can cause Compartment Syndrome. A traumatic injury, such as a fracture of one of the long bones in the body, can often trigger ACS. If the injured limb continues to swell after a rigid cast or tight dressing is applied, a compartment syndrome may result. In that case, the cast or dressing will have to be split or removed as the first step to help ease the problem and relieve the pain felt by the patient (University of Maryland Medical Center, 2007). It may take several hours for acute compartment syndrome to develop. Within the muscle compartment, swelling and/or bleeding creates pressure on capillaries and nerves. When the pressure in the compartment exceeds the blood pressure within the capillaries, the capillaries collapse. This disrupts the blood flow to muscle and nerve cells. Without a steady supply of oxygen and nutrients, nerve and muscle cells begin to die within hours. Unless the pressure is relieved quickly, this can cause permanent disability or death. Because of this, Acute Compartment Syndrome is generally treated as a medical emergency (Jenkins, n.d.). According to research by Hessmann, Ingelfinger and Rommens (2007), Acute Compartment Syndrome of the lower extremity is a life threatening emergency that requires urgent surgical treatment. Early detection and decompression are necessary in order to avoid permanent damage (University of Maryland Medical Center, 2007). Chronic Compartment Syndrome on the other (CCS) on the other hand is less threatening and is usually no cause for worry. It is an injury usually associated with athletes, most often in runners. Chronic Compartment Syndrome in athletes is distinguished by pain and swelling that was caused by exercise. For example, a runner will only experience the pain when he is running and not when he is riding a bicycle. It puts pressure on the blood vessels and nerves, and results in pain, swelling, weakness and, in the long run, loss of muscle coordination (Quinn, 2007). Jenkins M.D. (n.d.) illustrated the mechanism of Chronic Compartment Syndrome as resulting from the overuse of a certain group of muscles. This overuse would lead to local tissue swelling and result in a tight compartment. A tight compartment would also mean a decrease in blood supply, which can lead to more tissue swelling. It is occasionally accompanied by numbness or difficulty in moving the foot. Symptoms dissipate quickly when activity stops. Jenkins had said that what the athlete experiences is pain that begins during the activity and will progressively worsen. However, the pain would cease if it is rested. Another kind of Compartment Syndrome that is emerging as a complication for severely burned patients is called the Abdominal Compartment Syndrome. According to Tierney, McPhee and Papadakis (2006) increased intra abdominal pressures can cause excessively high peak inspiratory pressure (the breathing in of air due to the pressure from the earth’s atmosphere) and increase fluid requirement (the amount of water to be drank to avoid dehydration) considerably. Only 40% of patients with severe form of increased intra abdominal pressure survive. Patients suffering from Compartment Syndrome will feel severe pain as their primary symptom. The pain will not respond to any pain medication or to the elevation and compression of the affected limb. There may also be decreased sensation, weakness and paleness of skin for more advanced cases. It was mentioned before that Acute Compartment Syndrome must be treated immediately and the symptoms of which usually appear immediately after the accident or the trauma that caused it. For Chronic Compartment Syndrome however, severe pain will occur when a muscle running thorough a compartment is passively moved. For example, when the doctor moves the toes up and down, a patient with Compartment Syndrome in the foot or the lower leg will experience severe pain. The skin overlying the compartment will also be tensely swollen and red (University of Maryland Medical Center, 2007). For a doctor to accurately diagnose the Chronic Compartment Syndrome, the doctor must first rule out other conditions that would give similar symptoms. These may include stress fractures of the shinbone (tibia) and tendonitis (swelling of the tendons). To diagnose chronic compartment syndrome, the physician measures the intramuscular pressure before exercise, one minute after exercise, and five minutes after exercise. If pressures remain high, you have chronic compartment syndrome. Measuring the intramuscular pressure is done by inserting a needle in the affected area, that is, the compartment. The needle is then attached to a pressure meter. When the compartment pressure is greater than 45mmHg or when the pressure is within 30 mmHg of the diastolic blood pressured (or the lower blood pressure), the diagnosis is made. When Chronic Compartment Syndrome is suspected, this test must be performed immediately after the activity that causes pain (University of Maryland Medical Center, 2007). Surgery is usually the primary option in treating both Acute and Compartment Syndrome. To release the pressure building inside, long incisions are made in the fascia and wounds are generally left open (covered with sterile dressing as to prevent infection). The wounds will again be closed during a second surgery, 48-72 hours later. Sometimes, skin grafts may be required to close the wound as to avoid adding pressure to the underlying skin tissues (University of Maryland Medical Center, 2007). According to the October 6th medical report in Melbourne, Australia there is still a high mortality rate for Acute Compartment Syndrome if not diagnosed promptly and treated effectively. The research claims that “despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published report as to what constitutes best practice in the management of Acute Limb Compartment Syndrome.” (Compartment Syndrome, 2007) Based on the statement made, it proves that at present, there is not enough research regarding the treatment of Compartmental Syndrome. A lot of people become affected by this syndrome, which is in a way, easy to prevent. Conclusion In conclusion, the author of this paper merely hopes to shed some light on the subject of Compartment Syndrome, which is still a term that is alien to most people. By being very aware of this condition, its symptoms, early diagnosis and treatment, many of the complications of this syndrome that were mentioned in this paper will be prevented. People whose limbs are placed in casts also need to be made aware of the risk of swelling and need to see their health care provider or go to the emergency room if they have increasing pain under the cast despite elevation and pain medicine. There may be no foolproof way to prevent Compartment Syndrome, however, is to see a physician whenever pain is regularly felt during exercise. It should always be remembered that the pain must be treated right away so that it won’t get any worse. References Jenkins, Mark A. (n.d.) The Compartment Syndrome. Retrieved January 17, 2008, from http://www.rice.edu/~jenky/sports/cmpt.html Klaus J Burkhart,  Lars P Mueller,  Karl-Josef Prommersberger,  Pol M Rommens. (2007). Acute Compartment Syndrome of the Upper Extremity. European Journal of Trauma and Emergency Surgery, 33(6), 584-592.  Retrieved January 16, 2008, from Academic Research Library database. (Document ID: 1404774991) Martin H Hessmann,  Patrick Ingelfinger,  Pol M Rommens. (2007). Compartment Syndrome of the Lower Extremity. Review of medium_being_reviewed title_of_work_reviewed_in_italics. European Journal of Trauma and Emergency Surgery, 33(6), 589-599.  Retrieved January 16, 2008, from Academic Research Library database. (Document ID: 1404774981). Quinn, Elizabeth. (2007). Chronic Compartment Syndrome. Retrieved January 17, 2008 from http://sportsmedicine.about.com/cs/leg_injuries/a/leg3.html Tierney, L. M., McPhee, S. J., & Papadakis, M. A. (Eds.). (2006). Current medical diagnosis & treatment 2006 (45th ed.). New York: Lange Medical Books/McGraw-Hill. University of Maryland Medical Center. (2007). Compartment Syndrome. Retrieved January 17, 2008 from http://www.umm.edu/ency/article/001224.htm. Read More