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The compartment syndrome

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The compartment syndrome is a serious condition that involves a pressure increase within a muscle compartment. It can cause nerve and muscle damage as well as problems with the blood flow.

CAUSES

Thick layers of tissue called fascia separate groups of muscles in arms and legs. There is a confined space inside each layer of fascia called compartment that includes muscle tissue, nerves and blood vessels. Fascia surrounds these structures much like insulation covers wires.

Fascia does not expand. Any swelling in a compartment will lead to a pressure increase in that area, which will put pressure on muscles, blood vessels and nerves. If this pressure is high enough, blood flow to the compartment will get blocked, which can result in permanent muscle and nerve damage. If the pressure continues for a considerable period of time, the muscle can die, the arm or the leg won’t work anymore and it could be necessary to cut them off.

Swelling that leads to the chronic compartment syndrome occurs as a result of the practice of intense physical exercise, flexion activities with the hands in a repetitive way for a long period of time that require grasping such as driving a motorbike, playing tennis, etcetera. There are other causes of CS, but in this case we will only focus on arm, forearm and hand ones. The pressure within a compartment increases only during that activity.

Several moto GP riders have needed surgery for this injury, such as Jorge Lorenzo and Dani Pedrosa, this one twice. Tennis players, etcetera suffer from this injury as well.

Images: www.compartirpasion.com / www.selfisio.wordpress.com

SYMPTOMS

The chronic compartment syndrome ( physical exercise) causes intense pain that doesn’t stop after taking painkillers or raising the affected area. Symptoms become more severe as the disease gets worse. It starts with numbness, the need to extend the hand constantly and the difficulty to extend it passively, lack of strength, tingling, cold fingers, etcetera.

– Reduced sensitivity.
– Numbness.
– Pale skin.
– Severe pain aggravated by the passive extension.
– Weakness.

TESTS AND EXAMINATIONS

A physical examination will reveal:

– Pain when pressing on the area.
– Severe pain when moving the affected area( for example, one person with compartment syndrome in the forearm will suffer from intense pain when moving the fingers of the hands, when opening and closing them).
– Swelling in the area.

In order to confirm the diagnosis, doctor may need to measure directly the pressure in the compartment. This is done using a needle attached to a pressure gauge, catheter type “wick”, which is placed into the body area. This exam must be made during and after an activity that causes pain.

The normal intra-compartment pressure is of 15 mmhg, pressures from 20 to 30 mmhg prevent the normal circulation, that’s why they are considered diagnostic of the compartment syndrome.

TREATMENT

Surgery is required immediately. Otherwise, damage can become permanent.

Long surgical incisions are made through the muscle tissue in order to relieve the pressure. Wounds can be left open (covered by an sterile dressing) and be closed during a second surgery, usually 48-72 hours later.

Skin grafts may be needed to close the wound.

If the problem is being caused by a cast or a bandage, dressing must be loosened or cut to alleviate the pressure.

EXPECTATIONS (PROGNOSIS)

With an appropriate diagnosis and treatment, prognosis is excellent in order to recover the muscles and nerves within the compartment. However, general prognosis will be determined by the injury that leads to the syndrome.

If diagnosis is delayed, a permanent nerve damage and loss of muscle function can occur. This is more common when the injured person is unconscious or too sedated and therefore unable to complain of pain. Permanent nerve damage can occur after 12 to 24 hours of compression.

POSSIBLE COMPLICATIONS

Complications involve permanent nerve and muscle damage that can deteriorate dramatically. This can lead to an ischemia and cause the fatal Volkmann’s contracture.

In more severe cases, amputation may be needed.

WHEN TO CONTACT A MEDICAL PROFESSIONAL

A doctor should be consulted if you have suffered from an injury and have severe swelling or pain that don’t improve with pain medicines.

PREVENTION

There is probably no way to prevent this condition. The appropriate diagnosis and treatment can help to avoid many of the complications.

If you wear a cast, be aware of the risk of swelling. See a doctor or go to an emergency room if pain under the cast increases despite pain medicines and raising the area.

BOSCH TECHNIQUE

Rafael Bosch carries out an specific treatment for this disease with a success of 99 percent. This treatment has proven its effectiveness with more than a hundred patients. It is possible too to prevent its development with a session every 6 months.

Treatment is made with needles* in advanced stages. When the symtoms start, it is possible to discharge muscles with the hands as well, being the first option quicker and more effective and less painful for the patient.

This represents a big step forward not only for science but also for people suffering from this type of disease, since the only available treatment is currently surgery (fasciotomy), considering all the infection risks of this condition after surgery.

There is no available treatment to prevent it either. Occlusal splints have been used but without achieving the expected results.

* Needles used for the treatments are acupuncture ones, although the technique has nothing to do with it.

 

In our Bosch Clinical Centre we will attend to you and make you a profesional diagnosis.

Ask us for an appointment

 
Photographs come from the sites of compartirpasion.com and selfisio.wordpress.com

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