1/26. Chronic compartment syndrome of the lower leg: a new diagnostic method using near-infrared spectroscopy and a new technique of endoscopic fasciotomy.A 19-year-old female basketball player had chronic compartment syndrome. During basketball playing, she complained of bilateral lower leg pain that disappeared after several minutes of rest. The intracompartmental pressure in the anterior compartment was 41 mm Hg on the right side and 29 mm Hg on the left side immediately after playing. Prolonged ischemia of the anterior compartment was observed in comparison with four normal controls using near-infrared spectroscopy. magnetic resonance imaging also revealed that the anterior compartment was mainly affected. Endoscopic fasciotomy was performed using an arthroscope, a transparent outer tube, and a retrograde blade. After the operation, her symptoms disappeared. Three months postoperatively, the anterior compartment pressure decreased and prolonged tissue ischemia improved. Endoscopic fasciotomy allowed us to cut the fascia safely and less invasively. We concluded that this technique is useful in treating chronic compartment syndrome in the anterior compartment of the lower leg.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/26. Effort-related chronic compartment syndrome of the lower extremity.Effort-related chronic compartment syndrome (ERCCS) of the lower extremity is often misdiagnosed, requiring repeated visits to the physician and subsequent delay in definitive treatment. The most significant causes of chronic leg pain in physically active individuals are stress fractures, shin splints, and "exercise-induced" or effort-related chronic compartment syndrome. In patients susceptible to ERCCS, the fascial compartments are too small to accommodate the associated 20% increase in muscle mass that typically occurs with heavy exercise. The increased pressure within a small unyielding compartment limits circulation and subsequent muscle function. The only appropriate conservative treatment is cessation of the offending activity. Early suspicion of the condition is paramount, because the definitive treatment is fasciotomy. ERCCS has only recently been recognized, and therefore it may be underdiagnosed. family physicians and general medical officers caring for otherwise healthy soldiers and athletes should be aware of ERCCS so that prompt orthopedic referral for evaluation and definitive treatment will not be delayed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/26. Compartmental syndromes in which the skin is the limiting boundary.Following closed fasciotomy, skin may become the limiting boundary of extremity swelling. The resulting increase in pressure within the limb may threaten its survival. Realizing this potential complications, we reserve closed fasciotomy for those cases in which only moderate swelling is anticipated. Following this procedure the patient is observed closely for evidence that decompression dermotomy is indicated. patients in whom severe swelling is present or anticipated are treated with fasciotomy and primary dermotomy. Wounds are closed by either primary or delayed skin graft. This approach has proven useful in the management of traumatized or vascularly embarrassed limbs in which swelling may compromise extremity viability.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/26. intermittent claudication in athletes.All reported cases have occurred in the anterior tibial or rarely peroneal compartments. Case I and V in this series follow this same pattern. Case II and III are unusual in that they are the first recorded cases of this syndrome occuring in the calf of a leg. In Case IV the syndrome was present both in the anterior compartment as well as in the calf. Case III in addition, demonstrated arteriographic evidence of impairment of blood flow preoperatively which was relieved by fasciotomy. It is this author's opinion that this syndrome develops due to obstruction of venous drainage by a rise in pressure in the myofascial compartment with exercise. Perhaps it occurs in athletes because the muscle hypertrophy in these patients in greater than that in the general public and the margin of safety is reduced. It is not necessary to perform complicated or painful investigative studies to make the diagnosis. Kennelly and Blumberg state that "a convincing history is all that is necessary," and the author is in complete agreement with this statement. Fasciotomy gives complete relief and is earnestly recommended both to relieve symptoms and to prevent the catastrophic consequences of muscle necrosis. In fact, in severe cases it is best to advise cessation of physical exercise until the operation can be done in order that this severe complication does not develop.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/26. Tissue pressure measurements as a determinant for the need of fasciotomy.An experimental and clinical tehcnique of measuring tissue pressures within closed compartments demonstrates a normal tissue pressure is approximately zero mmHg, and increased markedly in compartmental syndromes. There is inadequate perfusion and relative ischemia when the tissue pressure within a closed compartment rises to within 10-30 mm Hg of the patient's diastolic blood pressure. Fasciotomy is usually indicated, therefore, when the tissue pressure rises to 40-45 mm Hg in a patient with a diastolic blood pressure of 70 mm Hg and any of the signs or symptoms of a compartmental syndrome. There is no effective tissue perfusion within a closed compartment when the tissue pressure equals or exceeds the patient's diastolic blood pressure. A fasciotomy is definitely indicated in this circumstance, although distal pulses may be present. The measurement of tissue pressure aids in the early diagnosis and appropriate treatment of compartmental syndromes.- - - - - - - - - - ranking = 6.5keywords = pressure (Clic here for more details about this article) |
6/26. Compartmental syndrome and its relation to the crush syndrome: A spectrum of disease. A review of 11 cases of prolonged limb compression.A review of 11 cases of prolonged limb compression usually following drug overdose, revealed a spectrum of disease from isolated compartmental syndromes to full crush syndromes with renal failure. Residual limb contractures were moderate or severe in 80 per cent of the extremities involved. Five of the 11 patients demonstrated significant, systematic manifestations, Stage II or Stage III crush syndrome by our definition. The severity of the systemic manifestations is related to the amount of muscle tissue being subjected to elevated pressure and the length of time this pressure is maintained. Delay in hospitalization, delay in diagnosis, and delay in treatment prolong this period. The diagnosis should be made on the basis of the histroy of prolonged immobilization and the finding of a swollen extremity. Fasciotomy should be performed immediately, both to minimize residual limb contracture and to prevent the crush syndrome from developing secondary to myonecrosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/26. lower extremity compartment syndrome in an adolescent with spinal cord injury.OBJECTIVE: Describe the unusual complication of lower extremity compartment syndrome occurring in an adolescent with spinal cord injury (SCI). methods: Case presentation. RESULTS: A 17-year-old male with C5 asia A complete SCI developed a compartment syndrome of his lower leg on the ninth day postinjury. Presenting signs included an equinus deformity of the foot, blackened induration over the anterior tibia, circumferential erythematous markings over the calf, large urticarial lesions over the knee, and calf swelling. The presumed etiology of the compartment syndrome was excessive pressure from elastic wraps, which were placed over gradient elastic stockings. Pressures were 51 mmHg in the superficial posterior, 50 mmHg in the deep posterior, 33 mmHg in the anterior, and 34 mmHg in the peroneal compartments. The patient also developed rhabdomyolysis with myoglobinuria. In addition to supportive care, the patient underwent a dual incision fasciotomy for compartment release. CONCLUSIONS: The development of lower extremity compartment syndrome was probably a result of excessive pressure applied by elastic wraps. Elastic wraps should be used with caution in individuals with SCI.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/26. Exertional compartment syndrome and the role of magnetic resonance imaging.A 47-yr-old woman presented with a 1-yr history of progressive bilateral anterior lower leg pain and swelling with walking, which resolved 10 min after activity. Postexercise (forced dorsiflexion) magnetic resonance imaging revealed increased T2 signal intensity in the entire anterior muscle compartment, and anterior compartment pressures were elevated at rest and postexercise. Chronic exertional compartment syndrome can occur in some patients after even minimal physical activities, and magnetic resonance imaging without the use of radioisotopes was a useful adjunct for diagnosis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/26. Compartment pressures, limb length changes and the ideal spherical shape: a case report and in vitro study.BACKGROUND: Changes in compartment pressures have been noted during traction, reduction, and intramedullary fixation of fractures. Changes in limb length and compartment volumes are suspected contributing factors. Pressure and volume changes are known to be related in animal models. If an acute increase in limb length can adversely affect compartment pressures, reversal or delay of such an increase in length may be of value in the treatment and prevention of compartment syndromes. methods: A clinical example is presented in which a documented anterior compartment syndrome was successfully treated by deliberate loss of fracture reduction, without fasciotomy. Fracture reduction was later restored when swelling subsided. Anterior compartment pressures were recorded in response to limb length changes in osteotomized cadaver limbs stabilized with external fixation. RESULTS: The pressure in the anterior compartment varies directly with acute changes in the length of the leg, in an experimental model. Mathematical analysis indicates that available volume within a compartment varies inversely with acute changes in its length. CONCLUSIONS: Fracture reduction that restores the length of an acutely injured extremity may increase pressure in the compartments by decreasing available volume. Deliberate loss of reduction can decrease pressure in the compartments, offering a potential alternative to fasciotomy in the care of compartment syndrome in cautiously selected, monitored patients. Early stabilization without reduction, followed by delayed reduction, may be preferable during treatment of fractures prone to compartment syndrome. Decreased available compartment volume may contribute to compartment syndrome after distraction with intramedullary rods or skeletal traction.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
10/26. Chronic compartment syndrome caused by aberrant fascia in an aerobic walker.The following is a case presentation of a 36-yr-old female athlete who presented with the symptoms and signs of chronic anterior compartment syndrome. Pre-exercise and post-exercise tissue pressure measurements revealed increased compartment pressures in both of her anterior leg compartments. Aberrant fascial bands overlying and compressing the anterior compartments were discovered at the time of surgery. Fasciotomies led to complete recovery and return to previous levels of athletic activity. This is the first report of aberrant fascia as a cause of chronic anterior compartment syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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