scholarly journals Structural anatomy of deep fascia, it’s implication in the pathogenesis of compartment syndrome of upper limbs and objective assessment of the effect of fasciotomy

2020 ◽  
Vol 7 (10) ◽  
pp. 3374
Author(s):  
Neeraj K. Agrawal ◽  
Preeti Agrawal ◽  
Rahul Dubepuria
Keyword(s):  
Compartment Syndrome ◽  
Upper Limb ◽  
Road Traffic ◽  
Objective Assessment ◽  
Road Traffic Injury ◽  
Neurological Dysfunction ◽  
Deep Fascia ◽  
Compartment Pressure ◽  
Before And After ◽  
Compartment Pressures

Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.

scholarly journals Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. NP58-NP61 ◽  
Author(s):  
Elizabeth A. Miller ◽  
Anna L. Cobb ◽  
Tyson K. Cobb
Keyword(s):  
Case Report ◽  
Compartment Syndrome ◽  
Single Incision ◽  
Invasive Technique ◽  
Compartment Pressure ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
History Of ◽  
Forearm Pain

Background: Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. Methods: Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. Results: Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. Conclusions: This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

scholarly journals Forearm compartment pressures and grip strength in elite motorbike racers with chronic exertional compartment syndrome

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dominic P. O’Dowd ◽  
Heike Romer ◽  
Richard Hughes ◽  
Noel Harding ◽  
Samantha Ball ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Grip Strength ◽  
Exercise Programme ◽  
Post Exercise ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
The Mean ◽  
Compartment Pressures ◽  
Forearm Flexor

Abstract Background Remarkably little research has been published on chronic exertional compartment syndrome (CECS) of the forearm. This study investigated forearm flexor compartment pressure pre- and post-exercise in elite motorbike racers clinically diagnosed with CECS and assessed their grip strength before and after arm pump exercise. Methods Elite motorbike riders with a clinical diagnosis of CECS of the right forearm when racing were recruited during the opening rounds of a British Superbike season. Their grip strength and forearm flexor compartment pressures were measured before and after a set exercise programme. Results Of the 11 riders recruited to the study, 10 completed the full testing regime. The mean pre-exercise forearm compartment pressures [11.7 mmHg (range 7–17 mmHg)] significantly increased post-exercise [30.5 mmHg (range 15–45 mmHg)], with a mean increase of 18.80 mmHg (P < 0.0001). The mean pre-exercise grip strength [50.61 mmHg (range 37–66.7 mmHg)] decreased post-exercise to [35.62 mmHg (range 17.1–52.5 mmHg)], a mean decrease of 14.99 mmHg (P < 0.0001). Conclusion There is a statistically significant increase in the forearm flexor compartment pressures in elite motorbike racers with CECS, but with marked variability of these values. Grip strength decreases statistically significantly following onset of symptoms of CECS of the forearm.

scholarly journals Chronic Exertional Compartment Syndrome: A Review of Literature

2022 ◽  
Vol 5 (1) ◽  
pp. 01-03
Author(s):  
Phillip J Stokey ◽  
Sreeram Ravi ◽  
Ethan R Sawyer ◽  
Trevor T Bouck ◽  
Nabil A Ebraheim
Keyword(s):  
Compartment Syndrome ◽  
Review Of Literature ◽  
Compartment Pressure ◽  
Time Intervals ◽  
Chronic Exertional Compartment Syndrome ◽  
Level Of Activity ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
Vascular Compromise ◽  
Proper Diagnosis

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartments pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity.

Evaluation of Clinical and Venous Blood Parameters as Surrogate Indicators in Assessing the Need for Fasciotomy in Lower Limb Compartment Syndrome

2021 ◽  
pp. 153473462110590
Author(s):  
Rituparna Dasgupta ◽  
Nishith M. Paul Ekka ◽  
Arghya Das ◽  
Vinod Kumar
Keyword(s):  
Compartment Syndrome ◽  
Lower Limb ◽  
Venous Blood ◽  
Acute Compartment Syndrome ◽  
Neurological Deficits ◽  
Fisher Exact Test ◽  
Compartment Pressure ◽  
Exact Test ◽  
Significant Difference ◽  
Compartment Pressures

Acute compartment syndrome in the lower limb, a surgical emergency, may cause ischemic damage to muscles and neurological deficits leading to loss of function of the limb which may even require amputation, thus drastically affecting the quality of life of a patient. Fasciotomy for decompression is suggested when the differential pressure in the compartment of the leg is ≤30 mm Hg. However, compartment pressure measurement is not always feasible. Surgeons often find themselves in a dilemma in deciding the right treatment option for the patient: fasciotomy or conservative management. Since there is no universally accepted reference standard for the diagnosis of acute compartment syndrome at present, there is a need for definitive diagnostic variables so as to not delay fasciotomy in patients who need it, as well as to avoid unnecessary fasciotomies, especially when compartment pressures cannot be measured. In this observational study including 71 patients, based on the compartment pressures of the affected limb, treatment was done either with fasciotomy or conservative approach, and various clinical and biochemical parameters were evaluated in between these two groups. Statistically significant difference was found in the venous blood gas parameters between patients managed conservatively and with fasciotomy (MANOVA, P = .001). The results revealed the association of lower venous blood bicarbonate levels (independent sample t test, P = .021) and the presence of paresthesia (Fisher exact test, P = .0016) with the fasciotomy group. Also, pain on passive stretching of the affected limb was found to be significantly associated with a delta pressure of ≤30 mm Hg in any compartment (Fisher exact test, P = .002). These variables may thus be used as an alternative to the measurement of compartment pressure to assess the requirement of fasciotomy.

Compartment syndrome as a complication of intra-aortic balloon pumping

Perfusion ◽  
1986 ◽  
Vol 1 (3) ◽  
pp. 209-212
Author(s):  
JR Crockett ◽  
B. Glenville ◽  
JG Bennett
Keyword(s):  
Cardiac Output ◽  
Coronary Artery ◽  
Compartment Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Compartment Pressure ◽  
Low Cardiac Output ◽  
Set Up ◽  
Compartment Pressures

Intra-aortic balloon pumping (IABP) is a well accepted therapy in low cardiac output states. The complications reported with the use of IABP are varied. Development of a swollen, tender calf and loss of sensation and/or function, yet retaining a warm limb with the palpable peripheral pulses during or immediately after IABP is one such complication. We believe that this represents compartment syndrome following temporary or partial ischaemia. We set out to measure the compartment pressure in 13 patients in whom IABP was used following coronary artery bypass graft surgery. Our results show that the slit catheter method used in this study to measure compartment pressures gave reliable results, was easy to set up and use and provided early warning of compartment syndrome, thus facilitating early treatment and viability of all limbs affected.

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

2019 ◽  
Vol 40 (7) ◽  
pp. 853-858
Author(s):  
Reuben Lufrano ◽  
Matt Nies ◽  
Beau Ebben ◽  
Scott Hetzel ◽  
Robert V. O’Toole ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Primary Outcome ◽  
Acute Compartment Syndrome ◽  
Soft Tissue Coverage ◽  
Pressure Measurements ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
Fresh Frozen ◽  
Compartment Pressures ◽  
Theoretical Risk

Background: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. Methods: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. Results: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005). Conclusion: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. Clinical Relevance: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.

Review: Acute Compartment Syndrome of the Foot

2003 ◽  
Vol 24 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Eric Fulkerson ◽  
Afshin Razi ◽  
Nirmal Tejwani
Keyword(s):  
Compartment Syndrome ◽  
Direct Measurement ◽  
Vascular Injury ◽  
Diastolic Pressure ◽  
Sensory Neuropathy ◽  
Potential Complication ◽  
Compartment Pressure ◽  
Compartment Pressures ◽  
Frequent Presence

Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. The purpose of this article is to summarize and review the existing literature on this entity. Long-term sequelae of foot compartment syndrome (FCS) include contractures, deformity, weakness, paralysis, and sensory neuropathy. These complications are poorly tolerated, and often necessitate multiple procedures for rehabilitation. Therefore, the threshold for considering compartment syndrome and performing fasciotomy must be low to minimize such outcomes. The existence of nine foot compartments and frequent presence of complicating injuries necessitate multi-stick needle catheterization for direct measurement of compartment pressures. Fasciotomy is indicated when compartment pressure exceeds 30 mmHg, or if compartment pressure is greater than 10–30 mmHg below diastolic pressure. The approaches for compartment decompression generally include two dorsal incisions for access to forefoot compartments, and one medial incision for decompression of the calcaneal, medial, superficial, and lateral compartments.

Bilateral Simultaneous Fasciotomy for Chronic Exertional Compartment Syndrome

2005 ◽  
Vol 26 (12) ◽  
pp. 1007-1011 ◽  
Author(s):  
Steven M. Raikin ◽  
Venkat R. Rapuri ◽  
Peter Vitanzo
Keyword(s):  
Compartment Syndrome ◽  
Operative Procedure ◽  
Sports Participation ◽  
Return To Sports ◽  
Complication Rates ◽  
Compartment Pressure ◽  
Chronic Exertional Compartment Syndrome ◽  
Early Return ◽  
Exertional Compartment Syndrome ◽  
Before And After

Background: Chronic exertional compartment syndrome (CECS) occurs bilaterally in approximately 60% of patients. Fasciotomy is the primary corrective treatment. We hypothesized that bilateral fasciotomy can be done during the same operative procedure with early return to sports and low complication rates. Method: Sixteen patients had simultaneous bilateral lower extremity fasciotomies for CECS confirmed by compartment pressure testing before and after exercise. Ten patients had concomitant superficial peroneal neurolysis for associated numbness. All patients who were athletes (six runners; nine ball sports) (average age 25 years) had sports related pain limiting participation. Results: Patients were followed for an average of 16.4 (range 6 to 48) months. Full return to sports participation occurred at an average of 10.7 weeks. Three patients continued to have mild, but much improved, pain with active sports participation, while 13 were pain free. All 11 patients with exertional related numbness had resolution after operative release. All patients were satisfied and all patients stated that they would have simultaneous fasciotomies again if required. As a nonmatched comparison, three patients who had staged fasciotomies for bilateral CECS were also evaluated, but because of the small number no statistical comparison was made. All three also returned to their previous levels of sports participation, however, at an average of 22.7 months as compared to 10.7 weeks in patients with simultaneous bilateral releases. Conclusion: Bilateral simultaneous fasciotomies for CECS can be done safely and effectively with early return to sports participation and low complication rates.

EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

2019 ◽  
pp. 121-131
Keyword(s):  
Range Of Motion ◽  
Upper Limb ◽  
Functional Capacity ◽  
External Rotation ◽  
Treatment Protocol ◽  
Range Of Movement ◽  
Flexion Extension ◽  
Before And After ◽  
In The Beginning ◽  
And Function

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

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