Thousands of people every day suffer injury to part of their leg or forearm. Broken bones, burns, and penetrating trauma are daily occurrences and common complaints in America’s emergency departments.
Few patients or their families consider a fractured bone or burn will lead to amputation of a leg or part of the arm. But, for many, complications can lead to further injury within the muscle compartments of an arm or leg. This injury, known as compartment syndrome, poses a serious threat to patients worldwide. Unfortunately, the threat is often made greater because doctors or nurses overlook or ignore obvious signs and symptoms of compartment syndrome.
Limbs are in part composed of muscle groups which are divided into different sections, called compartments, and surrounded by strong tissue. Pressure may build up in these compartments – usually after trauma to the area or an injury – causing compartment syndrome. The pressure can rise from a reduction in the compartment capacity or an increase in the volume of fluid in the compartment. The increased pressure in the compartment jeopardizes the circulation and function of the muscle tissues, which can lead to the death of the tissues if not treated.
Compartment syndrome that occurs after an injury is called acute compartment syndrome (ACS), but it can also occur from overuse of a muscle, called chronic exertional compartment syndrome (CECS), which typically affects athletes. ACS is a condition that requires immediate treatment to save the muscles and the limb.
ACS most commonly occurs in the leg and forearm, but it can also happen in the foot, thigh, or buttocks. Long bone fractures cause 75 percent of ACS cases, and the most common of these are in the tibia bone in the lower leg; ACS develops in 1 to 10 percent of tibia fractures (Stracciolini & Hammerberg, 2014). However, it is also possible for ACS to occur without a fracture; sometimes strong and direct trauma to a compartment area can cause ACS. This includes injuries such as burns, excessively tight bandages, penetrating trauma, and vascular or arterial injuries. When there is no fracture involved, there is a greater risk for delayed diagnosis and treatment. Less commonly, ACS can occur without any type of trauma, such as when someone has a bleeding disorder, injects recreational drugs, or has a limb compressed for a prolonged period of time. No matter the cause, ACS results in a lack of oxygen reaching the tissues of the compartment.
Symptoms of ACS will progress rapidly over a few hours, which is why immediate treatment is so important (Stracciolini & Hammerberg, 2014). If any muscle compartment is tense and painful, ACS should be considered as a possibility. One common sign includes pain that is worse than what would normally be expected for the injury. It may feel like a deep ache, a burning pain, or a tingling/pricking sensation. The pain will usually begin within 30 minutes to 2 hours of the onset of ACS. On examination of the affected area, a doctor may notice other signs such as pain when stretching the muscle, a tense and wood-like feeling of the area, diminished sensation, and muscle weakness, which may start within 2 to 4 hours of ACS. A late symptom of ACS is paralysis.
If a patient is experiencing symptoms of ACS, they may be sent straight to surgery to treat it; however, it is preferable to measure the compartment pressure first to avoid unnecessary treatment. The most common measurement technique is to use a handheld manometer, also called a Stryker device. This works by injecting a small amount of saline into the compartment and then measuring the tissue pressure resistance. Handheld manometers are simple to use, and they give fairly accurate pressure readings; however, there are alternative ways to measure the compartment pressure if a manometer is not available. Normal compartment pressures are between 0 to 8 mmHg, but a normal reading does not rule out ACS (Stracciolini & Hammerberg, 2014). When the pressure of a compartment reaches 20 to 30 mmHg, the patient will begin to feel pain. The diagnosis of ACS can be made once the pressure in the compartment comes within 30 mmHg or less of the patient’s diastolic blood pressure. When the compartment pressure begins to approach the diastolic blood pressure, ischemia – inadequate blood flow to the area – will commence.
ACS is treated with a surgery called a fasciotomy where the pressure in the compartment is relieved by cutting open the muscle (Corliss, Elbaum, & Long, 2015; Stracciolini & Hammerberg, 2014). The muscle will typically be left open and bandaged loosely for a few days, and then the doctor will go back in to close it. Before the surgery can be performed, all external pressure should be relieved from the area, and the limb should be kept level with the patient’s torso. Painkillers and oxygen should also be supplied. If the fasciotomy is delayed, muscle tissue may die and the patient may require amputation of the limb.
The medical malpractice attorneys of Meyers Evans Lupetin & Unatin are well acquainted with the unfortunate consequences after doctors and hospitals fail to recognize signs of compartment syndrome. If you believe you or somebody in your family received substandard medical care for compartment syndrome and were seriously injured, we invite you to contact our office, share the unfortunate story and allow us to determine whether somebody should be held accountable.
Corliss, J., Elbaum, D. A., & Long, G. J. (2015). Patient information: Acute compartment syndrome (the basics). Retrieved from http://www.uptodate.com/contents/acute-compartment-syndrome-the-basics
Stracciolini, A., & Hammerberg, E. M. (2014, July 8). Acute compartment syndrome of the extremities. Retrieved from http://www.uptodate.com/contents/acute-compartment-syndrome-of-the-extremities