Compartment Syndrome and Tendinopathy Flashcards Preview

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Flashcards in Compartment Syndrome and Tendinopathy Deck (13):
1

What is compartment syndrome and what causes it?

- Elevated interstitial pressure within a closed fascial compartment resulting in microvascular compromise

- Causes include increased internal pressure (trauma/bleeding, muscle oedema/myositis, intracompartmental administration of fluids/drugs, re-perfusion in vascular surgery) and increased external compression (impaired consciousness, positioning in theatre, bandaging/casts, full thickness burns)

2

What is the pathophysiology of compartment syndrome?

- Pressure within the compartment exceeds pressure within the capillaries

- Muscles become ischaemic and develop oedema through increased endothelial permeability

- Necrosis begins in the ischaemic muscles after 4 hours

- Ischaemic nerves become neuropraxic. This may recover if relieved early, permeant damage may result after as little as 4 hours.

- Compromise of the arterial supply

3

Why is timely management of acute compartment syndrome crucial?

- 1hr (nerve conduction normal, muscle viable)

- 4hrs (neuropraxia in nerves, reversible, reversible muscle ischaemia)

- 8hrs (nerve axonotmesis and irreversible damage, irreversible muscle ischaemia and necrosis)

- End stage (stiff fibrotic muscle compartments, impaired nerve function, clawing of limbs and loss of function)

4

What are the clinical features of compartment syndrome?

- Pain (especially on stretching of the compartment)

- Pallor

- Parasthesia

- Paralysis

- Pulselessness

- Swelling

- Shiny skin

- Autonomic responsiveness (sweating, tachycardia)

- Impaired conscious level

5

What is seen on examination of compartment syndrome?

- Deep nerves affected first as pressure is highest deeper in compartment

- If difference between diastolic BP and the compartment pressure is <30mmHg this is diagnostic of compartment syndrome

- Pulses present (until late stages) unless associated vascular injury

- Parasthesia and paralysis usually later

6

How is compartment syndrome treated?

- Open any constricting bandages

- Surgical release

- If late presentation consider non-operative treatment and splint in position of function

7

What are the compartments of the forearm?

- Extensor

- Flexor

- Mobile wad of three

8

What are the compartments of the leg?

- Deep posterior

- Anterior

- Lateral

- Superficial posterior

9

What are the compartments of the thigh?

- Anterior

- Adductor

- Posterior

10

What is tendinopathy?

- Chronic tendon injury of over use (repetitive loading)

- Degeneration, disorganisation of collagen fibres

- Increased cellularity

- Little inflammation

11

What is the pathology of tendinopathy?

- Probably not inflammation

- Deranged collagen fibres/degeneration with a scarcity of inflammatory cells

- Increased vascularity around the tendon

- Failed healing response to microtears

- Inflammatory mediators released IL-1, NO, PGs – cause apoptosis, pain and provoke degeneration through release of matrix metalloproteinases

12

How is tendinopathy diagnosed?

- X-ray can give information about limb to see if biomechanical problem

- US (Doppler) to see if increased flow around tendon

- MRI can show anatomical field to check tendon itself

13

How is tendinopathy treated?

- NSAIDs

- Activity modification

- Physiotherapy

- GTN can cause localised vasodilation in area

- PRP injection (platelet derived growth factors) can stimulate healing

- Extracorporeal shockwave therapy

- Prolotherapy (additional damage to stimulate healing)

- Topaz-radiofrequency coablation (small holes made and radiofrequency to stimulate healing)

- Operative (debridement, excision of diseased tissue)