Elevation of tissue pressure within a closed fascial compartment, causing a decreased arteriovenous pressure and decreased muscular perfusion. Acutely, compartment syndromes are caused by hemorrhage and/or edema within a closed space, or external compression or arterial occlusion that induces postischemic reperfusion. Health care professionals should be watchful for compartment syndrome in crushing injuries, burns, casted fractures, and wounds requiring heavy circumferential dressings. Chronic compartment syndromes (also known as exertional or recurrent compartment syndromes) may result from muscular expansion during exercise or decreased size of the anatomical compartment.
Both types of compartment syndrome occur most frequently in the lower arm, hand, lower leg, or foot and are marked by limb pallor, swelling, and pain. The overlying skin may feel hard. As intracompartmental pressure increases, distal neurovascular function may become compromised. Chronic compartment syndrome is definitively diagnosed by measuring the intramuscular pressure while the patient is at rest and during exertion.
Acute compartment syndromes should be managed with topically applied ice and elevation of the limb. External compression should be avoided because of the risk of increasing intracompartmental pressure. Absent or diminished distal pulses require prompt surgical consultation.
The patient with acute compartment syndrome may need a fasciotomy if symptoms are not resolved in 30 min. Fasciotomy may also be required to relieve the symptoms of chronic compartment syndrome.
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