Compartment syndrome - Signs and symptoms

The five traditional signs of acute ischemia in State: pain, paresthesia, pallor, absence of pulse and poikilotermia are not reliable and is manifest only in late stages of compartment syndrome. Symptomatic patient with compartment syndrome may experience a crescendo pain that exceeds the proportion of the original lesion. The pain is deep and the form of cramps and is aggravated by passive stretching of affected muscles. The patient may describe a sensation of tension in the State. Pain, however, should not be a sine qua non in compartment syndrome.Paresthesia or tingling sensation is an early symptom.
On the evidence of trauma and clinical examination should alert medical coarse deformation of the possibility of developing a compartment syndrome. Comparison with normal member of the hit is useful. Consideration excessive vigorous a fracture of the tibia should be avoided because it exacerbates the irritation of the lower rear compartment.
Compartment syndrome has three phases in its evolution:
Alarm Phase:It is characterized by pain, there are two types of pain being assessed:Spontaneous pain, often disproportionate to the severity of trauma, as tension and sometimes throbbing and can not be correlated with sensory innervation territories, does not disappear completely after analgesics, opioid, or even after proclivitate. This occurs when the pressure reaches 30 mm Hg in the compartment. If the patient does not perceive pain (severe neurological disease with dissociative sensory-motor, polyneuritis, postspinala anesthesia) or can not be expressed by altered consciousness where it is difficult to diagnose.Pain induced by passive stretch test, augmented by passive elongation of the muscles affected. This type of pain is a sign of onset although significant is nonspecific and can occur after any trauma that causes muscle damage.
Phase stasis:Pain in affected muscle groups with the characteristics described above will expand rapidly at the initial distal fingers, where the lesion becomes intense. Volume increases significantly comparable to the area healthier, with leg and ankle swelling.Measure the diameter of the affected leg compared with healthy member. Consistent muscle groups which is pathognomonic for compartment syndrome is wood. The skin is glowing, energized and with drawing venous obvious. Neurological impairment: includes power the sensing and paraesthesia followed by first the localized hypoesthesia distal fingers and extending centripetal.Disorder is the first sign of sensory peripheral nerve ischemia, ie the deposit intracompartimentala pressure 30 mm Hg considered borderline value for resistance to peripheral nerve ischemia.Damage consists of power the inability to conduct the types of movements generated by muscle contractions in the affected area.Distal pulse is present at the onset of the condition. In most cases of ankle edema is difficult but ultrasound pulse Doppler evaluation clarify the issue.
Phase of the disease and postoperative complications:Postoperative motor deficits resulting from compartment syndrome are initially treated with appropriate ortotice devices. If the function does not return within a year of tendon transfer and other forms of reconstructive surgery may be considered. Volkmann contracture is a deformity of the residual limb which persists for weeks or months after acute ischemia untreated by persistent arterial insufficiency. Approximately 1-10% of cases of compartment syndrome, Volkmann contracture develops.Infection is a severe complication of compartment syndrome.Diestezia hyperesthesia and residual pain may also occur. They can submit slowly over time. Diphenylhydantoin or phenytoin, gabapentin and carbamazepine are helpful in these conditions.