Compartment Syndrome

Question 1

Which of the following are features of compartment syndrome?

1 - increased pressure within myofascial compartment
2 - reduced blood flow
3 - hypoxia of tissue
4 - acute or chronic (acute compartmental syndrome is a medial emergency)
5 - may lead to irreversible muscle and neurovascular damage
6 - all of the above

Answer 1

5 - all of the above

• essentially the myofascial is like tights holding in muscles

Question 2

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. Which of the following is NOT a most common causes of this?

1 - trauma causing internal bleeding
2 - crush injuries
3 - burns (skin becomes tight and compresses the leg)
4 - electric shock
5 - infection
6 - fluid injections

Answer 2

5 - infection

• internal bleeding following a long bone fracture is most common

Question 3

When a patient has compartment syndrome due to trauma etc.. the tissues inside the compartments become compressed due to increased pressure. When the arteries are compressed they release a myriad of molecules. Which 2 molecules are released by the arteries that aim to increase blood flow, BUT ultimately further increase pressure in the compartment?

1 - histamines
2 - albumin
3 - coagulation factors
4 - nitric oxide

Answer 3

1 - histamines
- increases vascular permeability

4 - nitric oxide
- vasodilates blood vessels

• both essentially increase fluid leaking into the compartment

Question 4

At a cellular level, hypoxia of the muscle cells reduces ATP levels in mitochondria, meaning the Na+/K+ ATPase pump does not function. This can further increase fluid being drawn into the muscle cells and further increasing compartment pressure. Why do muscle cells draw fluid into them?

1 - increased K+ concentration
2 - increased Na+ concentration
3 - increased Ca2+ concentration
4 - increased Cl- concentration

Answer 4

2 - increased Na+ concentration

• Na+/K+ ATPase pumps Na+ out of cell
• no pump means Na+ remains in the cell and fluid moves into the cell to dilute
• muscle cells can rupture and leak fluid and proteins into the compartment and further increase compartment pressure

Question 5

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. What medications can cause this?

1 - anti-coagulants, anabolic steroid use, IV drugs
2 - anabolic steroid use, IV drugs, NSAIDS
3 - anti-coagulants, anabolic steroid use, NSAIDS
4 - anti-coagulants, NSAIDS, IV drugs

Answer 5

1 - anti-coagulants, anabolic steroid use, IV drugs

• anti-coagulants = increased risk of bleeding
• anabolic steroid = rapid expansion of muscles in a less elastic fascial sheath

Question 6

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. Anywhere can be affected that contains compartments, but where are the 2 most common?

1 - forearm
2 - hand
3 - thigh
4 - buttock
5 - foot

Answer 6

1 - forearm
2 - hand

2 - lower leg

Question 7

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. Which of the following are common presentations of compartment syndrome?

1 - excruciating pain is most common and obvious
2 - pain upon stretching
3 - tense limbs
4 - decreased muscle function
5 - numbness and tingling
6 - reduced distal pulses
7 - all of the above

Answer 7

7 - all of the above

Question 8

All of the following are the 6 Ps of compartment syndrome, EXCEPT which one?

1 - pain
2 - paresthesia
3 - pulselessness
4 - pallor
5 - poikilothermia
6 - perfusion
7 - paralysis

Answer 8

6 - perfusion

• pain is most common
• paresthesia = burning/pins and needles
• poikilothermia = inability to regulate temperature

Question 9

Pain is one of the 6 Ps of compartment syndrome. Which of the following are important in pain when we are trying to confirm the diagnosis of compartment syndrome?

1 - pain out of proportion to the injury
2 - pain continues despite immobilisation
3 - pain is worse when stretching the muscle
4 - all of the above

Answer 9

4 - all of the above

Question 10

Hypoxia and ischaemia of tissues can lead to necrosis of that tissue. This can lead to fibrosis and shortening of muscles. If this occurs in the flexors of the forearm, this can present as what?

1 - volkmanns contracture
2 - carpal tunnel syndrome
3 - dupuytren’s contracture
4 - cubital tunnel syndrome

Answer 10

1 - volkmanns contracture

Question 11

Which of the following are complications of compartment syndrome?

1 - tissue necrosis
2 - muscle necrosis
3 - renal failure and sepsis
4 - volkmanns contracture
5 - all of the above

Answer 11

5 - all of the above

Question 12

Although compartment syndrome relies heavily on medical history, examination, and the 6Ps (pain, paresthesia, pulselessness, pallor, poikilothermia and paralysis). Rhabdomyolysis can occur, which allows us to measure which 2 biochemistry measures that can help diagnose compartment syndrome?

1 - CK and LDH
2 - CK and troponin
3 - CK and myoglobinuria
4 - myoglobinuria and LDH

CK = creatine kinase
LDH = lactate dehydrogenase

Answer 12

• Creatine Kinase) 1000-5000 U/ml
• Myoglobinuria (can cause renal failure)

BOTH ASSOCIATED WITH MUSCLE DAMAGE AND CAUSE URINE TO LOOK LIKE TEA

Question 13

If compartment syndrome is confirmed, how would this be treated?

1 - analgesia and bed rest
2 - phlebotomy and analgesia
3 - urgent fasciotomy
4 - leg elevation and fluids

Answer 13

3 - urgent fasciotomy

- for good outcomes surgery is required in 2-3 hours