Compartment Syndrome of the Forearm: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
[[Compartment Syndrome]] of the forearm is a condition in which pressure inside the closed osseofascial compartment increases to such an extent that there is a compromise of microcirculation, leading to tissue damage<ref>Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Advances in orthopedics. 2015;2015.</ref>. It may or may not be preceded by fracture or traumatic injury. Although uncommon, compartment syndrome of the forearm is a well recognized diagnosis that can lead to significant morbidity and mortality if not diagnosed and treated early in the clinical course<ref>Kistler, J.M., Ilyas, A.M. and Thoder, J.J., 2018. Forearm compartment syndrome: evaluation and management. ''Hand clinics'', ''34''(1), pp.53-60.</ref>. | [[Compartment Syndrome]] of the forearm is a condition in which pressure inside the closed osseofascial compartment increases to such an extent that there is a compromise of microcirculation, leading to tissue damage<ref>Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Advances in orthopedics. 2015;2015.</ref>. It may or may not be preceded by fracture or traumatic injury. Although uncommon, compartment syndrome of the forearm is a well recognized diagnosis that can lead to significant morbidity and mortality if not diagnosed and treated early in the clinical course<ref name=":0">Kistler, J.M., Ilyas, A.M. and Thoder, J.J., 2018. Forearm compartment syndrome: evaluation and management. ''Hand clinics'', ''34''(1), pp.53-60.</ref>. | ||
== Etiology == | == Etiology == | ||
==== Traumatic ==== | |||
* Fractures of the forearm, including both diaphyseal forearm fractures and fractures of the distal radius<ref>Prasarn ML, Ouellette EA. Acute compartment syndrome of the upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Jan 1;19(1):49-58.</ref> | |||
==== Non-traumatic ==== | |||
* reperfusion injury, angioplasty or angiog- raphy, intravenous line extravasations, injection of illicit drugs, coagulopathies or bleeding disorders, hematoma in patients treated with anticoagulants, and even insect bites<ref name=":0" /> | |||
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== Relevant Anatomy == | == Relevant Anatomy == | ||
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accompanied with paresthesias of the hand depending on the clinical course. The compart- ment syndrome may or may not be preceded by fracture or traumatic injury. | accompanied with paresthesias of the hand depending on the clinical course. The compart- ment syndrome may or may not be preceded by fracture or traumatic injury. | ||
* � Compartment syndrome hallmarks have been the 5 Ps: pain out of proportion, pallor, paresthesias, paralysis, and pulselessness. Pain out of proportion and pain with passive stretching of the fingers are considered the first and most sensitive signs of compartment syndrome in an awake patient. | |||
== Testing / Imagery (ie x-rays, ultrasound, nerve conduction tests) == | == Testing / Imagery (ie x-rays, ultrasound, nerve conduction tests) == | ||
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== Surgery == | == Surgery == | ||
* Adequate decompression of the forearm requires fascial release of both the dorsal and volar compartments, with the volar compartment best released from the carpal tunnel distally to across the lacertus fibrosus proximally. | |||
* Fasciotomy wounds must be assessed every 48 hours to 72 hours and additional soft tissue coverage procedures for wound closure are common. | |||
== Prognosis == | == Prognosis == | ||
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Definition/Description[edit | edit source]
Compartment Syndrome of the forearm is a condition in which pressure inside the closed osseofascial compartment increases to such an extent that there is a compromise of microcirculation, leading to tissue damage[1]. It may or may not be preceded by fracture or traumatic injury. Although uncommon, compartment syndrome of the forearm is a well recognized diagnosis that can lead to significant morbidity and mortality if not diagnosed and treated early in the clinical course[2].
Etiology[edit | edit source]
Traumatic[edit | edit source]
- Fractures of the forearm, including both diaphyseal forearm fractures and fractures of the distal radius[3]
Non-traumatic[edit | edit source]
- reperfusion injury, angioplasty or angiog- raphy, intravenous line extravasations, injection of illicit drugs, coagulopathies or bleeding disorders, hematoma in patients treated with anticoagulants, and even insect bites[2]
Relevant Anatomy[edit | edit source]
Risk factors / comorbidities[edit | edit source]
Clinical Presentation[edit | edit source]
typically presents with swelling of the forearm and patients complain of pain and difficulty with hand and wrist motion, particularly with passive motion. It may also be
accompanied with paresthesias of the hand depending on the clinical course. The compart- ment syndrome may or may not be preceded by fracture or traumatic injury.
- � Compartment syndrome hallmarks have been the 5 Ps: pain out of proportion, pallor, paresthesias, paralysis, and pulselessness. Pain out of proportion and pain with passive stretching of the fingers are considered the first and most sensitive signs of compartment syndrome in an awake patient.
Testing / Imagery (ie x-rays, ultrasound, nerve conduction tests)[edit | edit source]
Examination[edit | edit source]
Differential diagnosis[edit | edit source]
Rehabilitation approaches[edit | edit source]
Surgery[edit | edit source]
- Adequate decompression of the forearm requires fascial release of both the dorsal and volar compartments, with the volar compartment best released from the carpal tunnel distally to across the lacertus fibrosus proximally.
- Fasciotomy wounds must be assessed every 48 hours to 72 hours and additional soft tissue coverage procedures for wound closure are common.
Prognosis[edit | edit source]
Helpful Resources[edit | edit source]
References[edit | edit source]
- ↑ Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Advances in orthopedics. 2015;2015.
- ↑ 2.0 2.1 Kistler, J.M., Ilyas, A.M. and Thoder, J.J., 2018. Forearm compartment syndrome: evaluation and management. Hand clinics, 34(1), pp.53-60.
- ↑ Prasarn ML, Ouellette EA. Acute compartment syndrome of the upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Jan 1;19(1):49-58.
