Compartment syndrome

Compartment syndrome is a pathological condition that develops against the background of increased pressure inside a certain limited space. There may be many causes, but the essence boils down to the fact that inside a certain cavity is formed increased partial pressure, due to which pressure is exerted on the walls of the cavity, there is a mechanical stretching of the membranes and muscle layer, pain develops, various functional and structural disorders. Subjectively at the initial stages is perceived as a feeling of pressure and stretching in the area of a certain cavity, after which other symptoms of pathology join. Often requires surgical intervention. However, there are also traditional methods of treatment. [1]

Abdominal compression syndrome in surgery

It is a set of factors including pathological structural and physiological processes in the body, which entail an increase in pressure in the abdominal region. The most severe condition is considered a sharp increase in intra-abdominal pressure. In this case, a person feels the increasing pressure on the walls of the abdominal cavity, on the internal organs. At first there is only pressure, and the associated discomfort, but gradually the symptoms increase, pain appears.

The condition is dangerous because the cavity may rupture, as well as systemic disturbance of blood circulation and blood pressure, up to stroke and necrosis. Such a condition in surgery is called abdominal compression syndrome, because the pathology is localized in the abdominal (abdominal) cavity. You can try traditional methods of treatment, but most often they are ineffective, so you have to resort to radical methods of treatment. [2]

Epidemiology

According to statistics, myofascial and abdominal syndromes are most often diagnosed. The first is observed in about 45% of cases, the second - in 50%. Some researchers and clinicians distinguish other forms of compartment syndrome, but they account for no more than 5%. In about 30% of cases, the cause is various internal diseases, predisposing factors. In 15% the cause is tumors, hematomas, severe edema. About 40% of pathology is due to various traumas, injuries, mechanical compression of the cavity or muscle. The remaining 15% is due to various other causes, which can be many, for example, increased pressure against the background of hypertension, violations of the functional state of the kidneys, liver, spleen, heart. [3]

Statistics show that about 40% of pathology ends up with various complications, in 10% of cases peritonitis and severe disorders of the functional state of the liver and GI tract develop. In 9% of cases, liver and kidney pathology develops, which often progresses and ends in death. Chronic heart failure develops in about 11% of cases, about 12% are liver pathology, 8% - spleen pathology, 10% - renal failure. Often these pathologies develop in complex. In all 100% of cases develops a violation of homeostasis, barrier function of mucous membranes. [4], [5]

Causes of the compartment syndrome

There is a fairly large number of reasons why compartment syndrome can develop. First of all, it is determined by the form of pathology. So, the abdominal form develops mainly as a result of paresis of the intestine, the development of obstruction. Violation of its functional state, atony. It often develops as a side effect after various therapeutic and diagnostic invasive procedures, such as laparoscopy, especially if it was carried out in an emergency, without prior preparation of the patient. It is also often caused by copious infusion therapy, which leads to an increase in the interstitial fluid volume.

Often the reason for the development of compartment syndrome is trauma, especially multiple trauma to the abdominal cavity, resulting from trauma, compression of the abdominal cavity walls. Often automobile accidents, industrial accidents cause fluid to accumulate in the retroperitoneal cavity and develop increased pressure. Damage to the diaphragm, spine, surrounding internal organs and pelvic region, can cause compartment syndrome to develop. There are also many congenital, anatomical factors predisposing to the development of pathology.

In the myofascial (muscle) form of compartment syndrome, the cause usually lies in improper loading of the muscle, trauma, mechanical damage. In addition, the damage can be due to genetic factors, predisposition, congenital injuries. Often improper application of a tourniquet, bandage, cast, entails an increase in pressure inside the muscle. It should be taken into account that the pressure can continue to increase only up to certain, limited indicators, after which the cavity ruptures. To reduce the traumatic effect, special medications are used. If they are not effective, surgical treatment methods are resorted to.

Pressure can also be exerted by a tumor, hematoma, surrounding damaged tissues, displaced and dislocated bones, and severe swelling. [6]

Risk factors

All factors that can exert pressure on the human body are considered as major risk factors. These include mechanical factors that are in direct bodily contact with the structures of the human body (tourniquets, corsets, pressure bandages, displaced bones).

External factors that cause an increase in blood pressure and then the pressure of other fluids in the body can also be a risk factor. This can be the pressure underwater (often experienced by scuba divers, divers, lifeguards, people diving to fairly great depths). Often such pathology develops in all people engaged in deep-sea diving, diving to great depths, engaged in extreme sports.

It is worth noting that the partial pressure of the fluid can increase in conditions of high altitude climate, thin air, in a state of weightlessness. Can be called an occupational disease of pilots, fighter pilots, mountaineers, astronauts, various testers. Often develops in laboratory conditions in employees of nuclear and thermal power plants.

People who have recently undergone intra-abdominal or intramuscular interventions, such as surgery, laparoscopic diagnostic or treatment procedures, are also at risk. Certain heavy medications and pharmaceuticals can act as risk factors. There is also a significantly increased risk in people receiving chemotherapy, patients with digestive tract tumors, abnormalities in vascular tone, blood pressure, heart disease, kidney disease, and edema. [7]

Pathogenesis

It is currently believed that the pathogenesis is based on a violation of blood pressure, as well as a violation of pressure in the cavity of certain organs. Depending on the form of pathology. So, in the abdominal form, violations occur in the abdominal cavity. With myofascial form, the pressure of fluid in the muscles increases. The process starts as a result of an increase in pressure by at least 15 units, after which the pathological processes only increase and progress, the condition worsens.

An increase in pressure over 30 units is very dangerous because further disorders may develop, up to multi-organ failure. It is dangerous to maintain high intra-abdominal pressure for a day, because it entails a violation of the functional state of organs, as well as their necrosis, disruption of systemic blood flow, blood supply to organs. Develops such a phenomenon as ACS and IAH, which triggers a number of other pathological changes in the body, which affect the entire body, all organ systems. As a rule, symptomatology progresses gradually, as pressure increases and metabolic processes deteriorate.

So, first of all, there are disorders at the local level. These can be disturbances in the muscle layer, or in the abdominal cavity. Pressure rises, local blood flow is compromised. The exchange between tissue fluid and blood and lymph deteriorates. This leads to the fact that metabolites remain in the tissue fluid, poisoning the body. Hypoxia also increases, and simultaneously with it hypercapnia (as a result of which there is a sharp decrease in oxygen and an increase in the level of carbon dioxide first in the tissue fluid, and then, in the blood, in the total systemic blood flow).

It is worth noting that as blood pressure rises, blood pressure increases, pain syndrome gradually appears. The process spreads beyond the affected cavity through the nearby arteries and veins, the blood supply to the surrounding tissues is disturbed, the condition of mucous membranes is disturbed, the wall-to-wall oxygenation falls.

It is especially dangerous for the abdominal cavity, because immediately peristalsis, intestinal motility is disturbed, stagnation develops, the level of acidity drops both directly in the stomach cavity and in the mucous membranes. This reduces the reactivity of the intestine, receptors, violates digestive processes. Even if the pronounced pathologies are not yet noticed, and well-being has not deteriorated, at the level of histology, the pathogenesis is already quite pronounced.

First of all, it draws attention to the fact that against the background of reduced acidity repeatedly increases the risk of cancer processes, respectively, can develop malignant (cancerous) tumors, which are often inoperable. Especially when localized in the stomach region. Gradual decrease in motility and peristalsis, the development of congestion, entails an increased risk of congestion, which only exacerbates the situation, and contributes to a further increase in intra-abdominal pressure.

Purulent, purulent-septic processes develop, which can progress to tissue necrosis and the development of peritonitis. The pathogenesis of peritonitis is associated with the development of inflammation, in which the entire abdominal cavity is infected. Often ends with sepsis (blood poisoning), and entails the death of surrounding tissues. It is accompanied by severe intoxication, in which endo- and exotoxins spread throughout the body.

Subsequently, there is a development of pathological processes affecting all areas of the intestine, including the small and large intestine. All this entails an increased load on the organs of the urinary system, the liver, which ceases to cope with the increasing amount of endotoxins, supported by infectious and purulent-septic pathological process. Intoxication increases, the load on the liver and other systems involved in the neutralization of toxins.

It is worth noting that there is a concomitant development of liver disease, autoimmune pathologies, hepatomegaly, splenomegaly. In many patients there is a combined development of hepatomegaly and splenomegaly. The final stage of pathogenesis can be severe renal and hepatic insufficiency, which entails impaired cardiac output, heart failure and multi-organ disorders. And this already acts as a negative prognostic criterion, which ends in death if appropriate measures are not taken. [8]

Symptoms of the compartment syndrome

At the initial stages of the development of compartment syndrome, a person is bothered by a feeling of pressure from the inside, which develops in the cavity of internal organs. Most often, the pathology is subjected to the GI tract and muscles. Gradually, as the pathological process grows, the feeling of stretching, pressure from the inside increases. Many people note that they have a feeling that they are about to "burst" from the inside, or they "burst like a balloon". Pain then develops, which may spread throughout the affected area. There is often systemic damage to the blood vessels and a general increase in blood pressure and venous pressure.

One of the common symptoms of compartment syndrome, is an abnormal heart rhythm. This is manifested by a feeling of shortness of breath, which is combined with a feeling of high blood pressure, arrhythmias, tachycardia, less often - bradycardia. There may also be pain in the area of the kidneys, liver, heart. Respiratory function is disturbed, especially difficult to exhale. Dyspnea may develop, the frequency of respiratory movements may decrease. The main changes occur in the respiratory and cardiovascular systems, intrathoracic pressure increases.

The very first sign that indicates the development of pathology is a feeling of pressure on the walls of the hollow organs from the inside. This causes discomfort, which gradually increases and is accompanied by various unpleasant sensations, up to the development of pain syndrome.

Stages

The pathologic process proceeds in several stages. At the first stage, precursors and early symptoms develop, indicating an increase in blood pressure, fluid in the body cavities (depending on the area of injury). At the same time, the sensations do not give comfort, are quite unpleasant. There is a tendency for them to increase and intensify.

In the second stage of compartment syndrome, homeostasis is disturbed and the pathologic process begins to spread. It may still be insufficiently pronounced and perceptible, and the only symptom may still be pressure. But in laboratory parameters there are already signs of blood biochemistry disorders, early signs of endotoxemia.

On visual inspection, swelling and marked hyperemia of tissues are noted. Also on palpation, there is a thickening and inflammation of lymph nodes, painfulness. Blood flow increases on average from 10 to 20 units, and this is quite dangerous for the body. In particular, it creates an unsustainable load on the liver, and entails necrotic damage to the liver, about 15% of hepatocytes die, which is quite dangerous for the liver. This is clearly visible in biochemical analyses and is diagnosed, first of all, by an increase in the level of AlAT and alkaline phosphatase.

If untreated, the third stage of the pathological process occurs. If timely treated, reduce the pressure to the indicators of the physiological norm of a person, the condition is often normalized. But in the case of death of liver cells, their recovery is not observed. Damaged hepatocytes are replaced by connective tissue, which significantly increases the risk of liver cirrhosis, and creates an additional load on the kidneys, heart, respiratory system.

The third stage of compartment syndrome is associated with violations of the functional state of the kidneys, liver, heart, lungs. Accordingly, the probability of developing insufficiency of these organs increases sharply. Cardiocytes, hepatocytes, nephrocytes also begin to die. The death of a large proportion of cells is accompanied by a violation of the natural physiological state of these organs. It is also worth noting that in most cases the third stage ends with the development of multi-organ failure.

The fourth stage is the most severe, and often ends in death. Thus, the liver ceases to cope with toxins, the symptoms of intoxication increase. Blood pressure continues to increase, the condition worsens, the clinical picture of intoxication continues to grow. Tissue necrosis appears. The load on those tissues that remained alive, significantly increases, resulting in an increased risk of failure. In the kidneys, tubular filtration is disturbed, necrotic processes develop in the kidneys, as a result of which the kidneys can fail. Gradually, pathology increases, and this already creates multi-organ failure, as hormonal regulation is also disturbed. In particular, the renin-aldosterone system is disturbed, the functioning of the aldosterone system. Reduced and sometimes completely disappears diuresis. The person may become comatose or die.

The fifth stage of compartment syndrome, as such, does not exist, but some clinicians distinguish it. This stage is usually severe and irreversible, accompanied by severe intoxication, multi-organ failure. A person may be unconscious, in a comatose state. Edema of the brain, lungs develops, and everything ends in death. If a person is at this fifth stage, there have been no cases of recovery. If we exclude cases when a person is on artificial life support. [9]

Forms

There are several types of compartment syndrome. Most often, the division is based on the clinical picture and those basic symptoms that form the main complaints of a person, from the peculiarities of pathogenesis and affected organs.

The most common type of compartment syndrome is abdominal syndrome, which is accompanied by an increase in intra-abdominal pressure, as well as systemic blood flow disorders. It is also worth noting that it is this form of pathology that most often ends in a fatal outcome, since it entails a violation of the entire digestive tract, and also contributes to the development of malignant neoplasms in the stomach. Congestion is formed, which forms a source of infection and toxins, which is accompanied by intoxication of the body, atrophy of the muscle layer, paresis of the intestine, peritonitis.

The second form, which is quite common in medical practice - myofascial form, which is accompanied by disorders of the muscular system. The pressure inside the muscle increases, the condition of muscle fibers is disturbed. A distinctive feature is that this syndrome is most often accompanied by severe pain in the muscle area, and gradually the pain progresses, up to the lesion of the entire skeletal musculature. A characteristic feature is a progressive decrease in muscle tone, which may eventually end in paralysis of the muscles, complete failure of the limbs.

The most dangerous point is the defeat of smooth muscle musculature, in which the tone of smooth muscles that form internal organs, mucous and submucosal layers is reduced. It is also worth noting that in this case there can even be sudden death from cardiac arrest or respiratory arrest, as a result of complete paralysis of the respiratory musculature.

Less common type of compartment syndrome, is the intrathoracic form, in which the pressure increases in the area of the sternum, in the pleural cavity. The main negative consequence is an increase in intracranial pressure. This is due to the fact that the increase in pressure in the thoracic cavity, entails pressure on the intercostal areas, the thoracic spine, as well as the spinal cord. Gradually, the pressure also increases on the cervical spine, subcostal structures. Accordingly, the intracranial pressure also increases.

The reverse process is also often observed, in which craniocerebral trauma is accompanied by an increase in intracranial pressure. The process is accompanied by pressure on the stem structures and various parts of the spinal cord. Inside the thoracic cavity, there is also an increase in pressure. There is edema of the brain and spinal cord, blockade of the cerebral cortex, and the risk of ischemic brain lesions increases.

With combined lesions of the brain and abdomen, internal organs, there is an increase in pressure in the chest cavity. Edema increases and the brain undergoes further dysfunctional changes. The pressure begins to rise, both in the area of the brain and the peritoneum. At the same time, the pressure in the region of the sternum increases. This is accompanied by pronounced cardiovascular lesions, in which edema continues to increase. Pulmonary edema is quite dangerous, as it almost always ends in death.

Even much rarer are such types of pathology as compartment syndrome of the tibia, thigh, buttock, forearm, elbow. In most cases, the lesion is accompanied by a lesion of the muscular system. Most researchers do not distinguish these types in a separate category, but refer all these lesions to myofascial syndrome.

Abdominal compartment syndrome

Under the abdominal form of compartment syndrome means an abdominal lesion, which is accompanied by an intense increase in pressure in the area of the peritoneum. It is accompanied by unpleasant sensations, a feeling of pressure inside the abdominal cavity. The condition is quite severe and dangerous. Dangerous, first of all, with its complications. Quite quickly develop complications affecting the liver, kidneys, heart. Multiorgan failure develops, which is accompanied by coma and death.

Treatment is often medication, traditional, but radical methods are also resorted to. But these are extreme measures that are used if other methods are ineffective. Treatment is mainly aimed at reducing pressure in the abdominal cavity, reducing edema, pain relief. [10]

Compartment syndrome of the tibia

Often under the compartment syndrome of the lower leg is meant the myofascial form of this syndrome, which is accompanied by increased pressure in the muscles that form the ankle. The ankle joint also succumbs to significant deformation. Treatment is aimed at reducing pressure, eliminating pain and swelling, preventing paralysis and muscle atonia. [11]

Gluteal compartment syndrome

It is an injury to the gluteal muscles, in which the fascial pressure within the muscle fiber increases. This is a combination of factors that are accompanied by a set of changes, pathological phenomena that occur in a limited muscle space. As a rule, it begins with a local lesion of a single muscle and an increase in pressure in it, which is accompanied by ischemia and hypertension, with gradual paralysis and paresis.

Quite dangerous this condition due to the fact that muscle perfusion, severe edema develops. Hypertension. Part of the muscles become hypertrophied, part, on the contrary, in progressive accelerated rates, loses tone. Most often compartment syndrome in the gluteal muscle develops in connection with traumatic damage to both the muscle proper and its fascial layer.

Common symptoms include the development of post-traumatic edema, severe hypertension, hematoma, edema, and positional compression. Often, a progressive and rapidly growing tumor puts pressure on the muscle, resulting in increased blood pressure in the muscle. That is, the underlying pathogenesis is a gradual positional compression of the muscle, but at the same time, its volume remains the same. The muscle can withstand this progressive contraction only up to certain limits. At the same time, the increase in blood pressure continues to progress until the muscle ruptures or necrotic necrosis occurs.

The main signs are pain, which is accompanied by a feeling of pressure, compression, constant pulsation of increasing nature. The pain increases in the evening, and slightly decreases in the morning. The damaged joint also experiences significant damage, it becomes less mobile, its nutrition is disturbed, the amount of synovial lubricant, responsible for the safety and integrity of the joint, decreases. Also a characteristic feature is that the pain is significantly reduced with active movements of the affected area, and significantly increased with passive movements, especially when stretching a muscle, its compression. Also, if the position of the knee in relation to the buttock is changed, the pain also increases. Quite unpleasant phenomenon patients call tension of increasing character, swelling, flexion, paresthesias, hyperesthesias. There is also increased sensitivity on the skin. [12]

Compartment syndrome of the forearm

Quite often, after various accidents and disasters, compartment syndrome develops in the forearm. This is a condition in which the muscle is compressed or mechanically damaged, which is accompanied by increased pressure in the muscle fascia. A distinctive feature of this condition is pain of a moderate character, as well as the rapid progression of the pathological process, which quickly affects other parts of the body. For example, often in the pathological process involves both the shoulder department and the entire girdle of the upper extremities. Thus, a complication of forearm pathology is compartment syndrome of the shoulder, clavicle, and sometimes the thoracic region. [13]

Compartment syndrome in peritonitis

Compartment syndrome is often accompanied by peritonitis, just as peritonitis often develops this syndrome. So, with increased pressure in the abdominal cavity, stasis often develops, peristalsis and motility are disturbed, resulting in a decrease in tone, increasing the risk of complications, such as inflammatory processes, infectious processes. As the final stage of severe damage to the peritoneum, peritonitis may develop.

It is also common to see cases in which peritonitis develops (e.g., severe inflammation, fecal stasis, intestinal paresis, obstruction). In this case, peritonitis results in a sudden increase in pressure in the abdominal cavity, resulting in compartment syndrome. A characteristic feature is that this process develops rapidly. If in the first case it is a gradual, gradual process, accompanied by a gradual increase in pressure. In the second case, a rapid, rapid process develops, which is accompanied by a sharp rise in pressure in the peritoneum. [14]

Complications and consequences

Complications and various negative consequences develop quite quickly. They are severe, and often end in death. So, for example, with abdominal compartment syndrome, quite quickly develops a decrease in peristalsis, motility, decreased acidity. The complete functioning of the digestive tract is disturbed: congestion develops, atony of the large and small intestine, inflammatory and infectious processes develop, peritonitis. Against the background of reduced acidity is quite often the development of malignant tumors. The most dangerous are considered tumors localized in the stomach, since most of them are inoperable.

Complications of myofascial compartment syndromes are also considered dangerous. Often such complications are the consequences of muscle tone disorders, increased pressure in the fascia. So, quite dangerous is the condition in which the tone of the respiratory musculature decreases. Ultimately, this can end in paralysis of the respiratory center, absence of respiratory processes, respiratory arrest. Also quite often develop pathologies of cardiac activity, the normal functioning of the kidneys, liver, spleen is disturbed. Hormonal regulation of the body, immune status is disturbed, the intensity of metabolism decreases.

Compartment syndrome is often accompanied by pulmonary and cerebral edema. The most dangerous consequences can be considered cardiac, respiratory, renal, hepatic failure, which eventually develops into multi-organ failure, and leads to the development of coma, confusion, and death.

Compartment syndrome is a special pathological condition in which there is an increase in pressure in the cavity of organs. In this case, the walls of the organs are stretched, receptors are irritated, and a number of associated pathologies develop. The main symptom is a persistent feeling of pressure, which is necessarily increasing. As the pathology progresses, pain develops. Depending on the form of the syndrome, the pathological process can affect the muscles, or the abdominal cavity. The most common cause is traumatization or mechanical damage, squeezing the affected area. But there may also be other causes.

The pathogenesis is based on increased pressure of internal fluids on the walls of hollow organs. For example, an increase in intra-abdominal, intrathoracic, pleural pressure. The condition requires immediate diagnosis and treatment, because it is dangerous with its complications. One of the main complications is intestinal paresis (in the abdominal form), muscle paralysis (in the myofascial form). Peritonitis, intoxication, strokes, tissue necrosis, which end in multi-organ failure, coma, cerebral and pulmonary edema, and death are also common. [15]

Diagnostics of the compartment syndrome

To diagnose compartment syndrome, you should consult a general practitioner, who in turn will refer to the right specialist. In the case of an acute course, an ambulance should be called. The sooner the diagnosis is made and emergency care is provided, the safer the condition, the lower the risk of fatal outcome. In case of trauma, the diagnosis is made by a traumatologist.

Methods of diagnosing compartment syndrome are determined primarily by the form of pathology. In the myofascial form, for the purpose of diagnosis, a standard physical examination is carried out, during which standard methods of investigation are used, such as auscultation, palpation, percussion. This makes it possible to identify edema, hematoma, hyperemia, possible rupture, tissue thickening. It is important to track the rate of development of edema, the increase in symptoms. In traumatic compartment syndrome, the maximum pronounced edema is observed 5-12 hours after the injury. Also, the stage of compartment syndrome is judged by how long ago a tourniquet was applied (if available).

Analyses

Standard clinical tests are uninformative and are rarely used. However, even clinical tests of urine, blood, feces can tell an experienced diagnostician a lot. For example, they can show the approximate direction of pathological processes that are observed in the body. And on them it is already possible to judge about further changes, it is possible to predict the outcome of the disease, to assess the effectiveness of treatment, to determine the scheme of further research.

Instrumental diagnostics

Nowadays, there are special methods for measuring subfascial pressure that allow you to accurately determine the level of pressure. For this purpose, the Riva-Rocci device is used, which is a special mercury manometer with an injection needle. Modern medicine has numerous innovative methods that allow long-term monitoring of subfascial and intra-abdominal pressure. Undoubtedly, instrumental methods of diagnosis still remain the most reliable.

A one-time and occasional increase in blood pressure, or a slight increase in blood pressure, is not yet grounds for a diagnosis of compartment syndrome. In order to make this diagnosis, the blood pressure must rise by 40 units. In this case, emergency care should be provided immediately, because if this pressure persists for 5-6 hours, the muscles will undergo ischemic lesions with subsequent development of tissue necrosis.

There are also open methods of measuring intra-abdominal pressure. These are available if there is an open cavity. For example, a severe injury. Or such a procedure is done during laparoscopy and other invasive procedures. Also, the possibility of using direct measurement methods appears in the presence of drains, during peritoneal dialysis. Undoubtedly, these methods are the most accurate. But they are also dangerous. Therefore, they are carried out very rarely, and only if their implementation is justified and appropriate. It is worth noting that the procedure requires high precision and skill of the specialist who will carry it out. It is always necessary to take into account the high risk of complications. Therefore, if there is such a possibility, indirect diagnostics is carried out.

In the case of abdominal compartment syndrome, the diagnosis is based on the measurement of bladder pressure. This is because the pressure spreads to all points in the abdominal cavity without change (according to Pascal's law). Therefore, it will be the same in the bladder and at all points in the abdomen and retroperitoneum, as well as in the inferior vena cava. Daily bladder pressure monitoring is considered to be the most effective and accurate method of investigation. In addition, it is safe and harmless, there are no negative consequences for health.

For the purpose of such monitoring, an urimeter is used, which is a closed system with a measuring device and a built-in hydrophobic filter. But this method has its own contraindications. For example. It can not be used with damage to the bladder, squeezing it with a hematoma, tumor. In this case, to measure the pressure resort to a gastric tube, measuring intragastric pressure. In extreme cases, when it is impossible to use other methods, intra-abdominal pressure is measured by catheterization of the inferior vena cava. The catheter is inserted through the femoral vein.

Differential diagnosis

The differential diagnosis is based on the need to differentiate the signs of compartment syndrome from signs of other similar pathological conditions. Pain can be an important diagnostic criterion. Its character is also judged on many features of the course of pathology. The development of compartment syndrome is indicated by pain of pulsating character, which is traced quite deeply, in the inner layers of the muscle, organ. With a normal injury, the pain is usually superficial and pulsation is not felt. Also, the increase in pressure is indicated by pain with passive stretching and compression. With active movements, the pain is significantly reduced, the condition is relieved. With immobilization, the pain on the contrary decreases.

Zudek's syndrome

It is a pathologic condition that occurs as a result of compression or trauma. It is often the result of improper emergency care, or in the absence of qualified care for limb fractures. In this syndrome, neurodystrophy develops, followed by weakening and further death of the muscle layer.

Most often Zudek syndrome is seen after fractures (after the cast is removed). The bone may not fuse properly, putting pressure on the surrounding tissues. The main symptoms are the development of swelling, soreness, marbling of the skin, and coldness of the affected area. Sometimes in the affected area on the contrary, an increased local temperature develops. Often there is tingling, burning, itching in the area of the affected area.

In the future, necrosis of muscle fibers develops, and muscle tissues die off. The condition may end with paralysis. It also develops against the background of osteoporosis, dystrophic and necrotic processes. First of all, the pathogenesis is based on a neurogenic disorder, in which there is a violation of nerve conduction, a decrease in sensitivity, reactivity and response to the stimulus.

Diagnostic methods include ultrasound, radiography, and determination of body temperature using a thermal imager. Treatment is aimed at relieving pain syndrome, eliminating swelling, preventing tissue die-off. If there are any signs of Zudek syndrome, you need to see a doctor as soon as possible, and carry out the necessary treatment. Otherwise, the third stage is practically untreatable and ends in death.

Crash syndrome

It is a pathology that occurs as a result of a single intensive impact on the muscle of various traumatic factors. In this case, there is a sharp destruction of muscle tissue with the release of decay products of muscle tissue (myoglobin, cellular metabolites) into the blood. All this is accompanied by severe intoxication. The phenomenon is called rhabdomyolysis. In this case, there is poisoning by products of the decay of muscle tissue. There is a gradual failure of the kidneys with the development of renal failure, because the load on the kidneys and the entire urinary system is significantly increased. The symptoms of intoxication increase, multi-organ failure and death occurs.

The most common cause of Crash syndrome is a single damaging impact of high intensity. Approximately 50% of all cases occur in areas where hostilities, localized conflicts, bombings, terrorist attacks, explosions. It is also often observed in the zone of emergencies, disasters (earthquakes, tsunamis, floods, mass fires, collapses, under destroyed buildings). The pathogenesis may be based not only on the violation of the integrity of muscle tissue, but also the blockage of blood vessels, their occlusion, compression, or thrombosis, resulting in impaired blood circulation, and muscle tissue does not receive the necessary nutrition. Intoxication, dystrophy, hypoxia with hypercapnia develops. After tissue destruction, structural elements are released into the blood, spread throughout the body, and the structural and functional state of the entire organism is disturbed.

Prolonged compression syndrome

As a result of the muscle being in a state of prolonged compression, a syndrome can develop, which has been given the name prolonged compression syndrome. As can be seen from the name itself, the pathogenesis is based on a violation of trophics in muscle tissue, which develops as a result of the fact that muscle fibers are subjected to compression for a long time. The processes of blood circulation, innervation of the muscle are also disturbed. The outflow of by-product metabolites from the body is disturbed, there is an obstacle to the penetration of oxygen and nutrients into the muscle tissue.

As a result, carbon dioxide content increases in muscle tissue, metabolic products accumulate, nutrition and blood supply to the muscle are disturbed. Vessels are also subjected to occlusion, dystrophic changes. Accordingly, there are first functional, then - structural changes in muscle tissue, up to the disintegration of structural elements, tissue necrosis. Remains of muscle tissue are excreted into the bloodstream, transported throughout the body, which leads to further damage of internal organs by toxic substances.

Symptoms are numbness, redness of the affected area, pain, throbbing. At first, there is a local increase in temperature, swelling, hyperemia. Then the skin begins to turn blue, itching develops. The skin becomes cold, which indicates a serious violation of metabolic processes, a decrease in the blood supply of the muscle. Sensitivity, trophic processes are violated, symptoms of intoxication increase. Along with this, the pathology of internal organs also develops.

It is worth noting that prolonged compression syndrome can end in paralysis, disability, and therefore requires urgent medical attention. It is necessary to remove swelling as soon as possible, normalize nutrition and blood circulation in the tissues, and then eliminate symptoms of intoxication.

Treatment of the compartment syndrome

The etiologic treatment of compartment syndrome is most effective. This implies that, first of all, it is necessary to eliminate the cause that causes compression, and causes an increase in cavity pressure. It is necessary to restore the disturbed blood circulation as quickly as possible, normalize the conductivity of muscle tissue. To do this, rub the affected area with quick light movements. First do these with light superficial strokes, shaking. Deep movements can be dangerous, as they will lead to a violation of the integrity of the damaged vessels. Remove all bandages, dissect the cast if necessary, eliminate or loosen the equipment for skeletal traction. The limb is placed at the level of the heart. To normalize metabolic processes and blood circulation.

After the blood circulation is restored, remedies are applied that will maintain the optimal level of nutrition of the damaged tissues. It is important to ensure normal blood circulation, which will allow timely removal of by-products, metabolites from the body, as well as maintain an optimal level of oxygen, normal trophicity. To do this, anticoagulants, antispasmodics are used, which contribute to the elimination of hypercaogulation and vascular spasm. Additionally prescribe drugs that improve the rheological properties of blood. Most often prescribed reosorbilact and pentoxifylline. With severe pain, anesthetic agents are used. First, narcotic analgesics are prescribed. Usually the need for these drugs remains for the first 3 days after the injury. Gradually, as the pressure decreases, the pain subsides. You can switch to non-narcotic analgesics.

It is obligatory to use means aimed at relieving edema, since edema continues to aggravate the situation by disrupting blood circulation. With the help of sodium bicarbonate and other means, therapy aimed at eliminating acidosis is carried out.

Almost always treatment starts with conservative means. And only if it is ineffective, resort to radical methods.

In addition, medications, physiotherapeutic methods, folk remedies, homeopathy and phytotherapy are used. In rare cases, vitamin therapy and hormone therapy are also used.

Antibiotic therapy, antiviral treatment may be required. It is also important to maintain a proper diet, a sufficient level of physical activity, and observe the daily regimen.

Medications

When using any medication, precautions should be strictly observed. This is especially true if high blood pressure develops. As a basic precautionary measure, one should consider the need to consult a doctor at all times and follow his or her recommendations. It is also important, before starting treatment, to eliminate the cause that caused compartment syndrome. This is a basic rule, because without it, no remedy will be effective and there is a risk of complications and side effects. The main side effects are worsening of the condition, increasing pain, its spread to other areas, the development of swelling, impaired sensitivity, acidosis. The most severe side effect is trophic disorder, tissue necrosis, toxicosis.

Local remedies aimed at relieving pain and inflammation at the local level work quite well. For example, chondroitin ointment is used when there is severe pain, at the risk of developing infectious and inflammatory processes. Use up to 5-6 times a day, it all depends on the intensity of the compartment syndrome and the degree of its progression. It should be noted that the course of treatment is an average of 10-15 days. Used at all stages of the pathological process, but the greatest effect is achieved in the treatment of early stages, when there has not yet been a powerful disturbance of blood circulation and trophism.

Various painkillers are prescribed to relieve pain. Analgin is considered the most effective and safe. It is prescribed one tablet 2-3 times a day. The course of treatment is from 3 to 7 days, depending on the severity of the pathology, the degree of severity of pain and swelling syndrome. It is necessary with caution to take patients with a tendency to bleeding, since analgin strongly thin the blood. It is not combined with anticoagulants.

Spasmalgon is used to relieve spasms, muscle clamps, pain. Take 1-2 tablets (50-100 mg) 3-4 times a day. The duration of therapy varies from 7 days to a month.

In case of pronounced local edema, hyperemia of tissues, impaired local blood circulation, menovazine is prescribed. It is available as a gel, spray, or ointment. The form of the drug is chosen by the doctor. It has an analgesic and anti-inflammatory effect. Many specialists opt for a spray, because the spray is sprayed on the body surface in the place where the maximum severity of compartment syndrome is noted. After application, wait until the spray is absorbed, after which you can apply dry heat to the surface. This is the most convenient remedy that can be used in various situations. It is used in cases of increasing pain, as well as in severe attacks as needed. Moreover, the spray does not require rubbing and special preparation of the body. The course of treatment can vary from 5 to 60 days.

Vitamins

Help relieve symptoms of intoxication, relieve pain, bring the muscle to optimal tone. To eliminate compartment syndrome requires at least 60 mg per day of various B vitamins, C - 1000 mg, A - 420 mg, E - 45 mg.

Vitamin C is especially important because it relieves pain, spasm, intoxication, the effects of rhabdomyolysis and severe intoxication. It is especially necessary during the recovery phase, or at severe stages of pathology development.

Physiotherapy treatment

Various methods of physiotherapeutic treatment are used. They allow to improve trophics, normalize metabolic processes, restore sensitivity, normalize blood circulation. They are especially effective in complex treatment, as well as in the recovery period. The main methods of physiotherapeutic treatment are treatment with ultrasound, microcurrents, waves of different lengths, electrophoresis.

These procedures work well if they are alternated with massage and manual therapy sessions. The main purpose of these procedures should be to control pain, ensure complete relaxation of tense areas of the body, toning atonic, relaxed areas, increasing the ability of muscles to respond to stimuli, tactile sensations. It is important to restore proprioreceptor sensitivity.

Electrophoresis is used, with which drugs are injected directly into the damaged tissue. The depth of their penetration is regulated by microcurrent. Cryoprocedures, heat procedures are indicated. Sometimes electroprocedures are used. Electromyostimulation is important, with which microcurrents increase the electrical activity of skeletal and smooth muscles, normalize the electrical potential and reactivity of muscle fibers.

Acupuncture, also known as acupuncture, has similar properties. It significantly improves microcirculation, normalizes metabolic processes in tissues. No procedure will not be effective without therapeutic exercise, active and passive gymnastics. These methods allow you to achieve the desired state of the muscles, provide mobility, nutrition, normalize metabolic processes in the surrounding tissues, blood circulation, innervation.

Other physiotherapy treatments may also be used, depending on the doctor's prescription.

Folk treatment

• Recipe #1.

Homemade ointment is used for lubrication and rubbing in the area where pain, swelling or decreased sensitivity is most pronounced. Quite often this ointment is used during massage instead of massage oil. The main effect is achieved due to the warming and stimulating effect.

To prepare an ointment, you need to prepare the base in advance. It can be an ordinary beluga, sold in a pharmacy. It is enriched by adding auxiliary components: a little rosemary and eucalyptus. Stir until the ointment becomes homogeneous, even. Then we use it for external application.

• Recipe #2.

Apply balm: in a liter bottle of alcohol slowly pour the powder of ground plant material: cystoseira bearded, fucus vesicular, St. John's wort, oak bark, herb of the mountain bird, lavender flowers. All this is poured alcohol, insist at least 3-4 days. Use no more than 50 grams per day.

• Recipe #3.

In the area of the affected areas are often applied compresses and lotions. In this case, the following composition is used: 5-10 grams of buckwheat seed, plaunus pinnae, common cargazone, pincushion and nettle pour a liter of boiling water, cover with a lid.

Herbal treatment

At all times, compartment syndrome was effectively eliminated by treatment with herbs. So, to relieve the condition with severe pain and inflammation will help sage. Decoction is the optimal way to use it. The approximate ratio is 1:100 with boiling water, where 1 part - plant, 100 parts - water.

You can eliminate swelling with a decoction of chamomile. The flowers are used as a medicinal raw material. Prepare a decoction in the same concentration as sage. Take 2-3 tablespoons of flowers per glass of boiling water. You can drink in pure form, you can add honey (to taste). In a day you need to drink the entire volume.

Lavender - soothing effect, is responsible for relieving irritation, relieves pain. A tablespoon of flowers poured a glass of boiling water. Used infusion, for the preparation of which flowers, leaves and roots of lavender poured alcohol, insist 24 hours and drink a tablespoon three times a day. Decoction drink a glass a day. The decoction can also be used to make lotions, especially when pain and swelling develop.

Surgical treatment

Surgical treatment methods are used only if traditional methods are not effective. The main method of surgical treatment is fasciotomy. The aim of the operation is to reduce the intracavitary pressure.

Fasciotomy for compartment syndrome

When it comes to fasciotomy as a method of surgical treatment for compartment syndrome, the first thing to look at is normal anatomy. For example, normally the muscle is divided by fascia into separate segments. In compartment syndrome, there is an increase in pressure in the muscle. Fasciotomy is aimed at dissecting the fasciae. Thus, the surface area is increased, respectively, there is a decrease in pressure. The operation is performed under general anesthesia.

Prevention

The basis of prevention is the prevention of increased pressure in the cavity organs, muscles. To do this, it is necessary to avoid trauma, damage to bones, muscle structures, inflammatory processes, hypothermia, drafts. An important means of prevention is regular exercise, a mobile lifestyle, compliance with the rules of hygiene, work and rest. It is necessary to undergo regular medical examinations, medical examination. If early symptoms are detected, it is necessary to take therapeutic measures as soon as possible. It is also important to eat properly, include in the diet the necessary amount of vitamins, minerals.

Forecast

If you timely identify the cause of compartment syndrome, and carry out the necessary treatment, the prognosis will be favorable. At the same time, it is necessary to follow the necessary recommendations of the doctor. If the diagnosis and treatment is delayed, the prognosis can be unpredictable. In the absence of treatment, compartment syndrome often ends in disability, and even death.