1/16. Acute compartment syndrome complicating a distal tibial physeal fracture in a neonate.This case report of a neonate who developed an acute compartment syndrome secondary to a minimally displaced distal tibial physeal injury represents the youngest patient to be reported with such a condition. After undergoing emergency four-compartment decompression fasciotomies, the 4-week-old child had a return of normal neuromuscular function and anatomic remodeling of the fracture. It is difficult to diagnose compartment syndrome in a neonate. The patient can neither give a history, nor follow commands to cooperate with the exam. The physician must rely primarily on the physical examination; however, the quantitative measurement of intracompartmental pressure can corroborate the diagnosis of compartment syndrome. We have found using a monometer to measure intracompartmental pressure to be helpful in conjunction with a physical exam when evaluating a neonate suspected of having a compartment syndrome.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. The accessory flexor digitorum longus as a cause of Flexor Hallucis Syndrome.The Flexor Hallucis Syndrome has been associated with ballet and sports activities. It has been thought to represent over use with attendant tenosynovitis of the tendon in the fibro-osseous tunnel extending from the ankle to the midfoot. We report a patient with an accessory flexor digitorum longus who presented with classical clinical features of the syndrome. The patient's disabling symptoms persisted despite a year and a half of nonoperative treatment. They were finally relieved when the accessory muscle was excised. In addition to the previously described clinical features of the Flexor Hallucis Syndrome, the physical exam included abnormal fullness between the achilles tendon and the tibia. When the ankle was held in dorsiflexion, there was limited dorsiflexion of the lateral toes, which were tethered by the "cork-in-a-bottle" effect of the distal muscle mass of the accessory flexor digitorum longus muscle at the flexor retinaculum and fibro-osseous canal of the flexor hallucis longus. The MRI examination confirmed the presence of an abnormal muscle mass extending distal to the ankle joint with the foot in neutral. The study also demonstrated fluid in the ankle joint and fibro-osseous canal of the flexor hallucis, and marrow edema within the body of the talus consistent with chronic inflammation. Follow-up MRI six months after excision of the muscle revealed some scar formation at the site of the previously excised muscle and complete resolution of the joint effusion, fluid in the tunnel of the flexor hallucis, and marrow edema.- - - - - - - - - - ranking = 0.15196925988208keywords = physical (Clic here for more details about this article) |
3/16. thigh compartment syndrome after acute ischemia.thigh compartment syndrome (TCS) is a poorly recognized clinical condition that may follow reperfusion of acutely ischemic thigh muscles. The anterior muscle group appears to be at greatest risk because of its layered arrangement. Intense pain, swelling, and elevated compartment pressures characterize the early presentation in the affected muscle group. If untreated myonecrosis, myoglobinuria, and renal failure may result. TCS was observed in a patient who was treated for a gunshot wound to the left thigh. The superficial femoral and profunda femoris veins as well as the profunda femoris artery were disrupted. The superficial femoral vein and profunda femoris artery injuries were repaired but the mangled branches of the profunda femoris vein were ligated. Postoperatively he developed intense thigh pain, swelling, and elevated compartment pressures. Lateral thigh fasciotomy, extensive debridement of necrotic muscle, and delayed wound closure resulted in a full recovery. physicians should recognize the numerous clinical circumstances that could lead to TCS--particularly those associated with trauma or physical activity. Timely recognition and intervention may be both limb and life saving. Associated irreparable injury to the profunda femoris vein may aggravate this condition.- - - - - - - - - - ranking = 0.15196925988208keywords = physical (Clic here for more details about this article) |
4/16. When pain is out of proportion.What happened to each of the patients? On re-examination, the first person was in tears and unable to lie still, even after 20 mg of i.v. morphine sulfate. Capillary refill was still intact, but he had lost sensation to the dorsum of the foot and was unable to dorsiflex his toes. He had a marked elevation of compartment pressure, and his creatinine phosphokinase (see below) was twice normal. In the OR, a fasciotomy was performed. Some muscle necrosis had occurred. In the second patient, fluids were infused rapidly on arrival at the ED via the i.v. route. He was given morphine sulfate for pain control while we awaited laboratory results. After about 45 minutes, he produced dark red urine. His creatinine phosphokinase (diagnostic muscle enzyme test) was 190,000--nearly 1,000 times above normal. He also had evidence of liver and kidney damage, but no electrolyte abnormalities. With aggressive treatment, including furosemide and sodium bicarbonate, his kidney and liver function returned to normal, he survived the ordeal and was discharged. The group leaders took the third patient to a local ED, where cellulitis was diagnosed and oral antibiotics were prescribed. The pain and fever increased, and significant discoloration began spreading up her hand over the next 24 hours. The second ED visit resulted in an admission. When the findings progressed despite i.v. antibiotics, surgical exploration was performed with drainage, debridement of devitalized tissue and a change in i.v. antibiotics. The common feature of all of these conditions is pain out of proportion to few, if any, findings on physical examination. Swelling that causes much of the damage in each condition is frequently not appreciated clinically until the condition is well advanced. Remember, what you see is not necessarily what you get.- - - - - - - - - - ranking = 0.84803074011792keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Presentation of compartment syndrome without an obvious cause can delay treatment. A case report.Compartment syndrome is a serious condition which leads to chronic morbidity unless an urgent decompression of the affected area is performed. An increased intra compartmental pressure commonly occurs after a physical insult though rarer causes have been identified. We report an atypical presentation of compartment syndrome and subsequent delayed intervention where there was no identifiable aetiological factor. Frontline medical staff must rule out compartment syndrome early so that complications secondary to compartment syndrome can be avoided.- - - - - - - - - - ranking = 0.15196925988208keywords = physical (Clic here for more details about this article) |
6/16. thigh compartment syndrome secondary to intertrochanteric hip fracture in a quadriplegic patient: case report.compartment syndromes in the thigh are rare and the diagnosis may be difficult in the light of subtle early physical findings in the patient with spinal cord injury. Clinical awareness of the impending compartment syndrome is important to provide timely proper treatment and avoid disabling deformities. A compartment syndrome should not be ignored in the paraplegic, because the potential for late fibrosis and contractures may limit the independence of such patients. Greater awareness and index of suspicion are needed to successfully recognize and promptly treat the compartment syndrome in this patient population.- - - - - - - - - - ranking = 0.15196925988208keywords = physical (Clic here for more details about this article) |
7/16. Acute anterior thigh compartment syndrome complicating quadriceps hematoma. Two case reports and review of the literature.Acute compartment syndrome of the thigh has been reported infrequently. To date, only eight cases from isolated blunt trauma without fracture have been reported. Two additional cases caused by intramuscular hematomas following blunt, low-energy trauma, which were treated successfully with emergency fasciotomies, are presented. The morbidity from this syndrome varies from mild, with quadriceps weakness, fatigue, and myositis ossificans, to severe, with limb-threatening vascular compromise. morbidity can be avoided if a high level of suspicion is maintained, compartment pressures are measured, fasciotomies are performed, and hematomas are drained. Postoperatively, patients can expect a dramatic decrease in pain and a quick return of quadriceps function with aggressive physical rehabilitation.- - - - - - - - - - ranking = 0.15196925988208keywords = physical (Clic here for more details about this article) |
8/16. Acute anterior compartment syndrome in the thigh: a case report and review of the literature.An unusual case of acute anterior thigh compartment syndrome promptly recognized and successfully treated in a young athletic patient is presented and the literature reviewed. With the increased interest in physical fitness in today's society, this condition may occur more frequently than it is recognized. Prompt diagnosis and treatment can reduce morbidity.- - - - - - - - - - ranking = 0.15196925988208keywords = physical (Clic here for more details about this article) |
9/16. Acute compartment syndrome (anterior, lateral, and superficial posterior) following tear of the medial head of the gastrocnemius muscle. A case report.This case report documents an acute tear of the gastrocnemius muscle which resulted in an acute compartment syndrome of the anterior, lateral, and superficial posterior compartments of the leg. Prompt diagnosis by physical examination and Wick catheter, followed by surgical compartment release, resulted in a well-functioning extremity. Followup at 18 months revealed a normally functioning extremity, and Cybex evaluation revealed increased muscle strength in the involved extremity.- - - - - - - - - - ranking = 0.84803074011792keywords = physical examination, physical (Clic here for more details about this article) |
10/16. compartment syndromes. early diagnosis and a bedside operation.Delays in diagnosis and treatment of compartment syndromes of the lower extremities result in significant morbidity and mortality. knowledge of the anatomy of the lower leg compartments provides clues to earlier diagnosis as to the specific compartments involved in these syndromes. A simple physical examination is described that focuses on this. Furthermore, a simple "bedside" operation is described that provides excellent decompression of all of these compartments without fibulectomy.- - - - - - - - - - ranking = 0.84803074011792keywords = physical examination, physical (Clic here for more details about this article) |
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