22 Compartment Syndrome

Eric Lukosius and Kenneth F. Taylor

Abstract

Compartment syndrome in the upper extremity is a rare but potentially devastating condition resulting from a wide variety of insults that cause expansion of muscle fascial compartments. If inadequately treated in a timely fashion, resulting tissue ischemia may result in muscle and other soft tissue necrosis. Diagnosis is largely based on clinical suspicion but several ancillary studies serve to confirm its presence. Treatment involves surgically decompressing involved muscle tissue through appropriate fascial incisions.

Compartment syndrome – fasciotomy – forearm – hand – trauma

22 Compartment Syndrome

I. Definition

Compartment syndrome: Elevation of interstitial pressure in a closed fascial compartment, causing the perfusion gradient to fall below a critical value, leading to ischemia of the tissues within this confined space. ¹

II. Pathophysiology

Increased compartment pressures lead to increased venous outflow obstruction. Resulting increased capillary permeability through changes in oncotic pressure promotes further increase in compartment expansion. Once high enough, arterial obstruction occurs and leads to decreased tissue oxygenation. This ischemic state is initially reversible. ²

III. Etiology

Trauma: Examples include distal radius fracture, crush injury, gunshot, and animal bite.
- Most frequent cause ofacute compartment syndrome.
- High proportion of postfracture compartment syndrome occurs after fixation. ³
External compression
- Examples: Tight casts, dressings, and wraps.
Fluid extravasation
- Examples: Intravenous (IV) fluids, anticoagulation, bleeding disorders, and vascular injury.
Burns: Compression from circumferential eschar and increased tissue edema. ⁴
Exertional (chronic) compartment syndrome:
- Exercise-induced, reversible increases in pressure within fascial compartments which usually resolves without permanent sequelae when the activity ceases.
- Most typical in rigorous repetitive activity (rowers, swimmers, manual laborers).
- In presence of anomalous muscle; examples include extensor digitorum brevis manus and reversed palmaris longus.
- Additional diagnostic studies—dynamic compartment pressure measurements, magnetic resonance imaging, and near infrared spectroscopy. ⁵