
SHOULDER SURGERY

	SHOULDER ARTHROSCOPY ARTHROSCOPIC ACROMIOPLASTY ROTATOR CUFF REPAIR TOTAL SHOULDER REPLACEMENT TYPES OF SHOULDER SURGERY
SHOULDER CONDITIONS

	COMPARTMENT SYNDROME SHOULDER ARTHRITIS BURSITIS OF THE SHOULDER SHOULDER TENDONITIS ERB'S PALSY FROZEN SHOULDER SHOULDER FRACTURES ROTATOR CUFF TENDONITIS SHOULDER IMPINGEMENT SHOULDER SPRAINS & STRAINS SHOULDER DISLOCATION
PATIENT RESOURCES

	FREQUENTLY ASKED QUESTIONS BEFORE SHOULDER SURGERY AFTER SHOULDER SURGERY ANATOMY OF THE SHOULDER SHOULDER SURGERY GLOSSARY

Compartment Syndrome

What is compartment Syndrome?

Compartment syndrome is a condition that occurs when injury causes generalized painful swelling and increased pressure within a compartment to the point that blood cannot supply the muscles and nerves with oxygen and nutrients. Muscles in the forearm, lower leg and other body areas are separated by fibrous bands of tissues into compartments, and this fibrous tissue is very inflexible and cannot stretch to accommodate the generalized swelling. If left untreated, muscles and nerves fail and may eventually die. As the compartment syndrome progresses, the structures controlled by the muscles and nerves inside the compartment may fail to function.

While most often occurring in the forearm and lower leg, compartment syndrome can rarely occur in other parts of the body that have muscles contained in compartments, including the hands and feet.

Compartment syndrome may be acute due to swelling that arises from injury, or it may be chronic because of exertion usually from athletic exertion.

CAUSES - Acute Compartment Syndrome

Acute compartment syndrome usually develops after a severe injury, such as a car accident or a broken bone. Rarely, it develops after a relatively minor injury.
Conditions that may bring on acute compartment syndrome include:

A fracture.
A badly bruised muscle. This type of injury can occur when a motorcycle falls on the leg of the rider, or a football player is hit in the leg with another player's helmet.
Reestablished blood flow after blocked circulation. This may occur after a surgeon repairs a damaged blood vessel that has been blocked for several hours. A blood vessel can also be blocked during sleep. Lying for too long in a position that blocks a blood vessel, then moving or waking up can cause this condition. Most healthy people will naturally move when blood flow to a limb is blocked during sleep. The development of compartment syndrome in this manner usually occurs in people who are neurologically compromised. This can happen after severe intoxication with alcohol or other drugs.
Crush injuries.
Anabolic steroid use. Taking steroids is a possible factor in compartment syndrome.
Constricting bandages. Casts and tight bandages may lead to compartment syndrome. If symptoms of compartment syndrome develop, remove or loosen any constricting bandages. If you have a cast, contact your doctor immediately.

Chronic (Exertional) Compartment Syndrome

The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.

DIAGNOSIS - Physical examination at rest often provides little helpful information: you are unlikely to see any abnormalities unless examining immediately postexercise. It is vital to take a careful history, including training regimes. You will need to establish the specifics of the pattern of pain: how long after the start of exercise and at what intensity it sets in; how and when it eases off again.

Passive stretching of the involved muscle after exercise may increase your client’s pain. Over time you may notice muscle atrophy, and the client may report tenderness and increased tension in the involved compartment. But be careful with differential diagnosis: tenderness directly over the tibia is more likely to be a stress fracture, tibialis posterior tendinitis or periostitis.

One further rare condition can present with almost identical symptoms as chronic exertional compartment syndrome (CECS) and must be excluded: popliteal artery entrapment syndrome (PAES). This most frequently affects young male athletes who describe exertional calf pain with possible associated leg weakness and paraesthesia. PAES is the partial or complete occlusion of the popliteal artery in the popliteal fossa (back of the knee), secondary to aberrant anatomy. Weaker distal pulses and poor capillary refill of the extremity with exercise or with provocative manoeuvres (repeated ankle dorsiflexion with knee extension) and normal compartment pressures help differentiate PAES from chronic exertional compartment syndrome (CECS). Angiogram provides definitive evidence.

Coupled with a careful history, the gold standard for chronic exertional compartment syndrome (CECS) diagnosis is to measure the pressure within the affected compartment, first at rest, then at several points while exercising, and finally 5, 10 and 20 minutes after exercise. It is very important that symptoms are elicited during this process and measurements taken at intervals until the symptoms subside. This is usually an outpatient procedure, requiring the insertion of a pressure probe into the affected compartment.
Several non-invasive forms of investigation have been assessed for reliability of diagnosis, including MRI.

TREATMENT - If compartment syndrome is suspected, your health care provider will assess the pressure inside the affected region using a special probe. If compartment syndrome is diagnosed, surgery is generally required. Surgeons will open the affected region and make incisions in the fascia surrounding the swollen muscles. The wounds will be left open and covered with sterile bandages for several days until the swelling diminishes, at which time your health care provider can close the surgical wounds.

Identification of compartment syndrome and prompt treatment usually result in a good outcome. Failure to treat compartment syndrome promptly may result in extreme pain, as well as permanent damage to muscles and nerves, which may even require amputation of the affected limb.