scholarly journals Hand Compartment Syndrome

2021 ◽  
Author(s):  
Ioannis M. Stavrakakis ◽  
George E. Magarakis ◽  
Theodoros H. Tosounidis
Keyword(s):  
Compartment Syndrome ◽  
Pressure Measurement ◽  
High Pressures ◽  
Signs And Symptoms ◽  
Surgical Decompression ◽  
Clinical Image ◽  
Loss Of Function ◽  
Intracompartmental Pressure ◽  
Permanent Loss ◽  
Hand Disability

Compartment syndrome is defined by high pressures in a closed myofascial compartment, which affects initially the muscles and later the nerves and vessels. The hand is rarely affected, but if treated suboptimally, it results to a permanent loss of function. Eleven compartments are included in the hand and wrist. Diagnosis of compartment syndrome of the hand remains challenging. Pain out of proportion of injury and excessive swelling should raise suspicion towards a compartment syndrome. Intracompartmental pressure measurement contributes to the diagnosis, but it is not always reliable. Once the diagnosis of acute compartment syndrome has been made, decompression of all compartments is mandatory, in order to achieve a good outcome. Failing to manage this emergent condition properly leads to a significant hand disability. Our chapter includes the following sections: 1. Introduction. A brief description of the hand compartment syndrome is presented. 2. Anatomy. Special considerations regarding hand compartments are presented, 3. Etiology. 4. Diagnosis. Signs and symptoms are reported, as well as guidelines of the technique of intracompartmental pressure measurement. 5. Treatment. Faciotomies’ indications and operative technique are described in details. 6. Conclusion. Appropriate figures of the clinical image and surgical decompression are presented as well.

scholarly journals Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population

2017 ◽  
Vol 39 (01) ◽  
pp. 58-66 ◽  
Author(s):  
Johan de Bruijn ◽  
Aniek van Zantvoort ◽  
David van Klaveren ◽  
Michiel Winkes ◽  
Marike van der Cruijsen-Raaijmakers ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Predictive Model ◽  
Pressure Measurement ◽  
Large Population ◽  
Lower Leg ◽  
Leg Pain ◽  
Intracompartmental Pressure ◽  
Discriminative Ability ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome

AbstractKnowledge about lower leg chronic exertional compartment syndrome (CECS) is largely obtained from highly selected populations. Patient characteristics may therefore not be appropriate for the general population. Our purpose was to describe a heterogeneous population of individuals suspected of lower leg CECS and to identify predictors of CECS. Charts of individuals who were analyzed for exercise-induced lower leg pain in a referral center between 2001 and 2013 were retrospectively studied. Patients were included if history and physical examination were suggestive of CECS and if they had undergone a dynamic intracompartmental pressure measurement. Six hundred ninety-eight of 1411 individuals were diagnosed with CECS in one or more of three lower leg muscle compartments (anterior tibial, deep flexor, lateral). Prevalence of CECS peaked around the age of 20–25 years and decreased thereafter, although a plateau around 50 years was found. Age, gender, bilateral symptoms, previous lower leg pathology, sports (running and skating) and tender muscle compartments were identified as independent predictors of lower leg CECS. The proposed predictive model has moderate discriminative ability (AUC 0.66) and good calibration over the complete range of predicted probabilities. The predictive model, displayed as a nomogram, may aid in selecting individuals requiring an invasive dynamic intracompartmental muscle pressure measurement.

scholarly journals Compartment pressure changes after closed fractures of tibia

2016 ◽  
Vol 2 (3) ◽  
pp. 188
Author(s):  
Manju G. Pillai
Keyword(s):  
Compartment Syndrome ◽  
Great Majority ◽  
Signs And Symptoms ◽  
Definitive Treatment ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
College Hospital ◽  
Medical College ◽  
Closed Fractures ◽  
Upper Third

<p><strong>Background: </strong>Compartment syndrome is a potentially devastating situation. Raised intracompartmental pressure has been implicated as the primary pathogenic factor in compartment syndrome. The purpose of the study was early detection of compartment syndrome and corroborating the findings with other physical signs and symptoms, to prevent the onset of ischaemia and subsequent tissue changes that lead to crippling deformities.</p><p><strong>Methods:</strong> The present study was conducted in the Department of Orthopaedics, Pushpagiri medical college hospital, Thiruvalla over a period of 12 months.  Closed fractures of tibia admitted to the casualty unit within 36 hours of injury were selected for the study. A total of 24 patients were included with the majority in the age group of 31– 45 years. Whitesides technique was used to measure the compartment pressure. A differential pressure of less than 30 mm Hg was taken as the criterion for diagnosis of compartment syndrome. </p><p><strong>Results:</strong> The present study included 24 patients with affected 25 limbs.15 out of 25 limbs were with lower third fractures (60%) followed by upper third 6 (24%) and middle third 4 (16%). Out of 25 limbs 20 cases (80%) had associated fracture of fibula and 5 (20%) were not associated. In this study, out of 32% cases with increased compartment pressure, one case with upper third fracture (above 45 mm Hg) and one of the case with middle third fracture (20-30 mm Hg) with associated fibula had underwent immediate fasciotomy.</p><strong>Conclusion:</strong> Compartment pressure measurement is a very good index for predicting and preventing compartment syndrome. Fasciotomy to fully decompress all involved compartments is the definitive treatment for compartment syndrome in the great majority of cases. Delays in performing fasciotomy increase morbidity.

Vascular

2018 ◽  
Author(s):  
Adam Sierakowski ◽  
David Warwick ◽  
Roderick Dunn
Keyword(s):  
Surgical Treatment ◽  
Early Diagnosis ◽  
Compartment Syndrome ◽  
Vascular Injury ◽  
Upper Limb ◽  
Lower Limb ◽  
Vascular Pathology ◽  
Loss Of Function ◽  
Permanent Loss ◽  
Delayed Referral

Vascular pathology in the hand may present to many different specialties, and delayed referral to hand specialists is not unusual. We provide an overview of vascular hand anatomy and pathophysiology to enable early diagnosis and treatment. We discuss general assessment of vascular hand pathology, including vascular anomalies, vascular injury, and Raynaud’s disease. It is important to understand the diagnosis and emergency surgical treatment of compartment syndrome of the upper limb which if unrecognized can lead to permanent loss of function from post-ischaemic fibrosis (and may be less anticipated than lower limb compartment syndrome).

Critical Evaluation of Compartment Pressure Measurement by Saline Manometer in Peripheral Hospital Setup

2003 ◽  
Vol 33 (2) ◽  
pp. 100-103 ◽  
Author(s):  
S S Sangwan ◽  
K M Marya ◽  
A Devgan ◽  
R C Siwach ◽  
Z S Kundu ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Pressure Measurement ◽  
Developing World ◽  
Critical Evaluation ◽  
Surgical Decompression ◽  
Compartment Pressure ◽  
Orthopaedic Surgeons ◽  
Peripheral Hospital ◽  
Limb Trauma ◽  
Early Decision

A hundred limbs of patients suffering limb trauma were assessed by at least two different reviewers for symptoms of compartment syndrome, both clinically, and by a simple, locally devised apparatus for pressure measurement. We have found the apparatus to be very effective, safe, reproducible and simple. Orthopaedic surgeons working in peripheral hospitals in the developing world can make use of this apparatus which costs less than $5 to assemble. This technique may assist an early decision regarding surgical decompression at a peripheral hospital or referral to specialist unit, thus saving valuable time and expense.

scholarly journals EFFECT OF MAJJA BASTI AND BAHYA SNEHANA (PIZICHIL) IN AVASCULAR NECROSIS - A CASE REPORT

2021 ◽  
Vol 9 (10) ◽  
pp. 2572-2577
Author(s):  
Bunker Surendra ◽  
Dixit Neetu ◽  
Dash Babita
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Medical Science ◽  
Bone Destruction ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Long Bone ◽  
Loss Of Function ◽  
Permanent Loss ◽  
Male Patients

Avascular necrosis (AVN) also called osteonecrosis or a disorder resulting from a temporary or permanent loss of blood supply or interruption of supply to the bone. AVN is found in the age of 30- 40 years mostly. Blood carries essential nutrients and oxygen to the bone. When the supply is disrupted, the bone tissue became necrosed. AVN can occur at any bone but most commonly affects the ends (epiphysis) of a long bone such as thigh region bone i.e. femur characterized by the collapse of bone, pain, bone destruction, limping off the leg, loss of function of affected bone (temporary or permanent). Modern medical science has surgical treatment modalities like Arthroplasty, hip replacement and osteotomy etc having a higher failure rate is also cost worthy and has a poor prognosis. As per Ayurveda, the cases were diagnosed as Asthimajjagata vata vikara. In the present study, two male patients one is 45 years old another is 30 years old having signs and symptoms of Avascular necrosis and X- ray of bilateral hip joint showing AVN of the femoral head were taken into consideration and administered the therapy, Majja Basti, bahya snehana (pizichil) and the Shaman Kashaya i.e. Guggulu Tiktak Kashaya 20 ml BD for 15 days.significant relief with increasing functional femoral activities in the necrosed femoral head. Based on these case study it can be concluded that the Panchakarma treatment along with Shamana chikitsa is effective in the management of AVN of the femoral head. Keywords: Avascular necrosis, Asthimajja gata vata vikar, Majja Basti, Pizichil.

scholarly journals Specialised Chronic Compartment Measurement Clinic in a District General Hospital: Is it Worthwhile?

2009 ◽  
Vol 91 (6) ◽  
pp. 505-508 ◽  
Author(s):  
Nedal Zeineh ◽  
Antonella Ardolino ◽  
David O'Connor
Keyword(s):  
Compartment Syndrome ◽  
General Hospital ◽  
Pressure Measurement ◽  
Strong Predictor ◽  
Correct Diagnosis ◽  
District General Hospital ◽  
Successful Outcome ◽  
Intracompartmental Pressure ◽  
Negative Results ◽  
Chronic Compartment Syndrome

INTRODUCTION Chronic compartment syndrome is one of the conditions that cause exertional pain in the young. In this condition, a careful history taking is usually the key for making the correct diagnosis, but intracompartmental pressure measurement that has high sensitivity and specificity rates can add invaluable confirmation, especially when surgical decompression is indicated. In a district general hospital there is usually a logistical problem in performing compartmental pressure measurement. In this study, we describe our experience in dealing with such a problem by setting up a quarterly specialised clinic for intracompartmental pressure measurement that, according to our knowledge, is unique in the UK. PATIENTS AND METHODS We retrospectively reviewed the medical records of 42 patients referred to our specialised clinic and documented the referral patterns, clinical picture, additional investigations, pressure measurement results, final diagnosis and outcome of treatment. The intracompartmental measurement was recorded pre- and post-exercise on the treadmill for 1 min or 5 min and results were interpreted according to published criteria. RESULTS The mean age of the referred 42 patients was 33.1 years (range, 15–78 years). There were 16 positive results (38%) confirming the diagnosis of chronic compartment syndrome and four clinically characteristic cases of this condition with negative results. There were 22 negative results (53%), one borderline, and three patients were not tested for different reasons. All of the 10 patients who were treated surgically had positive pre-operative test results. CONCLUSIONS An inappropriate referral rate of approximately 52% was encountered that had a significant impact on the waiting time for the proposed test (5.7 months), which is far longer than the 18-week target for treatment in the NHS. We found that a positive test is a strong predictor of a successful outcome of surgical treatment. Such a specialised clinic, therefore, should only receive carefully assessed patients.

scholarly journals Identification of a novel homozygous loss-of-function mutation in FUCA1 gene causing severe fucosidosis: A case report

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110059
Author(s):  
Xinwen Zhang ◽  
Shaozhi Zhao ◽  
Hongwei Liu ◽  
Xiaoyan Wang ◽  
Xiaolei Wang ◽  
...  
Keyword(s):  
Amino Acids ◽  
Lysosomal Storage Disorder ◽  
Autosomal Recessive ◽  
Signs And Symptoms ◽  
Lysosomal Storage ◽  
Loss Of Function ◽  
Wild Type ◽  
Single Nucleotide ◽  
Whole Exome ◽  
Exon 1

Fucosidosis is a rare lysosomal storage disorder characterized by deficiency of α-L-fucosidase with an autosomal recessive mode of inheritance. Here, we describe a 4-year-old Chinese boy with signs and symptoms of fucosidosis but his parents were phenotypically normal. Whole exome sequencing (WES) identified a novel homozygous single nucleotide deletion (c.82delG) in the exon 1 of the FUCA1 gene. This mutation will lead to a frameshift which will result in the formation of a truncated FUCA1 protein (p.Val28Cysfs*105) of 132 amino acids approximately one-third the size of the wild type FUCA1 protein (466 amino acids). Both parents were carrying the mutation in a heterozygous state. This study expands the mutational spectrum of the FUCA1 gene associated with fucosidosis and emphasises the benefits of WES for accurate and timely clinical diagnosis of this rare disease.

Acute proptosis secondary to bilateral pansinus mucopyocele with orbital compartment syndrome: a rare presentation, its management and outcome

2021 ◽  
Vol 14 (7) ◽  
pp. e241972
Author(s):  
Khushboo Chauhan ◽  
Tanya Sharma ◽  
Bhavana Sharma ◽  
Samendra Karkhur
Keyword(s):  
Compartment Syndrome ◽  
Nasal Polyposis ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Guided Exploration ◽  
Rapid Relief ◽  
Maxillary Sinuses

A 37-year-old Indian female presented with forward protrusion of left eye for one week, associated with progressive diminution of vision. The patient had undergone sinus surgery for nasal polyposis a year ago. On examination, there was severe proptosis and limitation of extraocular movements in all gazes. CT-scan revealed a heterogeneous expansile mass, arising from left fronto-ethmoidal sinus, infiltrating left orbit. MRI showed T2-hyperintense, peripherally enhancing areas in bilateral nasal cavity (right >left), bilateral ethmoidal sinuses and frontal, sphenoidal and maxillary sinuses. Otorhinolaryngology consultation was sought and in view of vision threatening proptosis — with likely orbital compartment syndrome — emergent endoscopic guided exploration and orbital decompression was undertaken. Rapid relief of signs and symptoms was achieved, with normal vision, extraocular movements and resolution of proptosis. Cytology and microbiology ruled out infectious or malignant aetiology and helped in resolving a diagnostic dilemma. Histopathology confirmed the diagnosis of mucopyocele and follow-up period was uneventful.

Complete Bilateral Brachial Plexus Injury from Rhabdomyolysis and Compartment Syndrome: Surgical Case Report

2018 ◽  
Vol 17 (2) ◽  
pp. E68-E72 ◽  
Author(s):  
Daniel A Tonetti ◽  
Ivan S Tarkin ◽  
Kiran Bandi ◽  
John J Moossy
Keyword(s):  
Brachial Plexus ◽  
Compartment Syndrome ◽  
Clinical Presentation ◽  
Brachial Plexus Injury ◽  
Laboratory Data ◽  
Surgical Decompression ◽  
Sensory Function ◽  
Resonance Imaging ◽  
Pectoralis Muscles ◽  
Prolonged Immobilization

Abstract BACKGROUND AND IMPORTANCE Acute bilateral brachial plexus injury is rare and usually a result of traction injury. Immediate operative intervention is reserved for rare cases of ongoing compression of the plexus; the role for acute decompression of the brachial plexus secondary to compartment syndrome has not been previously described. In this report, we describe the technique and role for urgent brachial plexus decompression. CLINICAL PRESENTATION A 32-yr-old man presented with acute complete bilateral brachial plexus palsy due to focal rhabdomyolysis and brachial plexus compression after a night of excess alcohol and methadone ingestion. He had complete loss of motor and sensory function from C5 to T1, with the exception of partial sensory sparing of the C5 dermatome. Magnetic resonance imaging demonstrated diffuse muscular edema of the supraclavicular and infraclavicular fossae in addition to the pectoralis muscles and the deltoids bilaterally. He underwent urgent surgical decompression of his supraclavicular and infraclavicular fossae with fasciotomies of the pectoral muscles and the anterior deltoids, allowing direct visualization and decompression of the entire brachial plexus resulting in a near-complete functional recovery. CONCLUSION Neurosurgeons should include brachial plexus compression due to compartment syndrome in the differential diagnosis of patients with acute upper extremity weakness, particularly when associated with prolonged immobilization and/or substance abuse. Prompt surgical decompression should be performed in these patients if imaging and laboratory data suggest compartment syndrome and resultant neurological deficit.

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