RESUMO
This is a case of a 26-year-old active duty male with a 1-year history of distal anterolateral leg pain and numbness which would persist following activity cessation. He was referred to physical therapy and eventually orthopedic surgery for bilateral anterior exertional compartment syndrome and underwent bilateral anterolateral fasciotomies. One year after surgery, he continued to have pain along the posterior aspect of his lower legs with residual numbness over his left dorsomedial foot. He was referred to sports medicine for further evaluation and Botox injections without significant symptomatic changes. He subsequently underwent diagnostic ultrasound of his lower legs which showed multiple entrapment points of the left superficial peroneal nerve along the fasciotomy scar. An additional electrodiagnostic study showed left superficial peroneal sensory mononeuropathy. Eighteen months following surgery, he received his first perineural injection therapy (PIT) treatment. A mixture of lidocaine and D5W was prepared to achieve 1 mg/cc which was then injected along his tibial, saphenous, and sural nerves. Following four PIT sessions, the patient's overall lower extremity pain, weakness, and functionality had improved. This case demonstrates potential benefit with PIT in patients with refractory symptoms following surgery for chronic exertional compartment syndrome. These symptoms may be due to chronic irritation of cutaneous nerves and they may benefit from treatment with PIT. Our case may represent a possible paradigm shift in the conservative treatment of chronic exertional compartment syndrome, especially when refractory to surgical compartment release.
Assuntos
Síndrome do Compartimento Anterior , Síndromes Compartimentais , Humanos , Masculino , Adulto , Síndrome Compartimental Crônica do Esforço , Hipestesia , Doença Crônica , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Síndrome do Compartimento Anterior/etiologia , Síndrome do Compartimento Anterior/cirurgia , Síndrome do Compartimento Anterior/diagnóstico , Perna (Membro) , Fasciotomia/métodos , DorRESUMO
CASE: A 26-year-old man presented to the emergency department with atraumatic right leg pain after a period of low-impact activity. He was discharged and returned 3 days later with findings of acute compartment syndrome. CONCLUSION: We present a case of delayed diagnosis of acute exertional compartment syndrome (AECS) in the setting of rhabdomyolysis, leading to detrimental sequelae. Practitioners with a high degree of clinical suspicion can make a prompt and accurate diagnosis by physical examination alone, allowing early treatment of AECS.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Adulto , Síndrome do Compartimento Anterior/cirurgia , Exercício Físico , Fasciotomia , Humanos , MasculinoRESUMO
The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as 'shin splints'. We aimed to review clinical entities that come under the umbrella term 'Exercise-induced leg pain' (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.
Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/terapia , Dor/etiologia , Síndrome do Compartimento Anterior/complicações , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/terapia , Atletas , Traumatismos em Atletas/complicações , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/cirurgia , Síndromes Compartimentais/terapia , Tratamento Conservador , Diagnóstico Diferencial , Exercício Físico/fisiologia , Fasciotomia , Fraturas de Estresse/complicações , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Humanos , Traumatismos da Perna/complicações , Masculino , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/terapia , Dor/diagnóstico , Fraturas da Tíbia/complicações , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/terapiaAssuntos
Síndrome do Compartimento Anterior/induzido quimicamente , Dependência de Heroína/complicações , Hipertensão Intra-Abdominal/induzido quimicamente , Dor Musculoesquelética/induzido quimicamente , Síndrome do Compartimento Anterior/diagnóstico , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/cirurgia , Extremidade Inferior/fisiopatologia , Masculino , Dor Musculoesquelética/diagnóstico , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Patients with Chronic Exertional Compartment Syndrome (CECS) have exercise-limiting pain that subsides at rest. Diagnosis is confirmed by intramuscular compartment pressure (IMCP) measurement. Accompanying CECS, subjective changes to gait (foot slap) are frequently reported by patients. This has not previously been investigated. The aim of this study was to investigate differences in barefoot plantar pressure (BFPP) between CECS cases and asymptomatic controls prior to the onset of painful symptoms. METHODS: 40 male military volunteers, 20 with symptoms of CECS and 20 asymptomatic controls were studied. Alternative diagnoses were excluded with rigorous inclusion criteria, magnetic resonance imaging and dynamic IMCP measurement. BFPP was measured during walking and marching. Data were analysed for: Stance Time (ST); foot progression angle (FPA); centre of force; plantarflexion rate after heel strike (IFFC-time); the distribution of pressure under the heel; and, the ratio between inner and outer metatarsal loading. Correlation coefficients of each variable with speed and leg length were calculated followed by ANCOVA or t-test. Receiver operating characteristic (ROC) curves were constructed for IFFC-time. RESULTS: Caseshad shorter ST and IFFC-times than controls. FPA was inversely related to walking speed (WS) in controls only. The area under the ROC curve for IFFC-time ranged from 0.746 (95%CI: 0.636-0.87) to 0.773 (95%CI: 0.671-0.875) representing 'fair predictive validity'. CONCLUSION: Patients with CECS have an increased speed of ankle plantarflexion after heel strike that precedes the onset of painful symptoms likely resulting from a mechanical disadvantage of Tibialis Anterior. These findings provide further insight into the pathophysiology of CECS and support further investigation of this non-invasive diagnostic. The predictive value of IFFC-time in the diagnosis of CECS is comparable to post-exercise IMCP but falls short of dynamic IMCP measured during painful symptoms.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Transtornos Traumáticos Cumulativos/diagnóstico , Transtornos Traumáticos Cumulativos/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Esforço Físico/fisiologia , Velocidade de Caminhada/fisiologia , Suporte de Carga/fisiologia , Adolescente , Adulto , Síndrome do Compartimento Anterior/fisiopatologia , Fenômenos Biomecânicos/fisiologia , Doença Crônica , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Militares , Músculo Esquelético/inervação , Nervo Tibial/fisiopatologia , Adulto JovemRESUMO
BACKGROUND Acute compartment syndrome (ACS) of the thigh after elective primary total knee arthroplasty is rare. If not recognized and treated promptly, devastating consequences may result. Certain regional anesthesia techniques are thought to mask the symptoms of acute compartment syndrome, but there are no cases reported of adductor canal catheters masking the symptoms of thigh compartment syndrome. We report a case where symptoms and diagnosis of acute anterior thigh compartment syndrome were not masked by a functioning adductor canal catheter. CASE REPORT A 56-year-old male developed anterior thigh compartment syndrome after an elective primary total knee arthroplasty. Surgery was performed under spinal anesthesia with periarticular local infiltration analgesia. Postoperatively, an adductor canal catheter was placed, atraumatically, under ultrasound guidance in the recovery room with a plan to begin a continuous infusion of 0.2% ropivacaine 10 hours after the periarticular injection. Six hours after surgery, the patient complained of tightness and 10/10 pain in his right thigh, which was initially managed with parenteral opioids with moderate success. Continuous infusion through the adductor canal catheter was started and pain improved to 6/10 aching pain. Nonetheless, two hours after starting the continuous infusion, the patient reported tightness, swelling, and 10/10 pressure-like pain that was not relieved by the peripheral catheter infusion or PRN boluses of additional opioids. Due to the patient's symptomatology compartment pressures were measured. The anterior compartment pressure was 47 mm Hg and emergent anterior compartment fasciotomy was performed. CONCLUSIONS In this case, a functioning adductor canal catheter did not mask symptoms of, or delay diagnosis of, acute compartment syndrome in the thigh.
Assuntos
Raquianestesia , Síndrome do Compartimento Anterior/diagnóstico , Catéteres , Artroplastia do Joelho , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Acute compartment syndrome (ACS) is the result of increased intracompartmental pressure (ICP), and to avoid a delay in diagnosis requires ICP measurement. This study was designed to compare 2 available methods with Bland-Altman analysis for measuring ICP in experimental animal models, healthy volunteers, and patients with suspected ACS to evaluate their agreement and interchangeability. METHODS: In 20 New Zealand White rabbits, we inflated a tourniquet to stop arterial blood flow to establish ACS rabbit models, of which ICP was measured and recorded by the Whitesides apparatus and the invasive arterial blood pressure monitor system (IABPMS) before and after modeling. The same 2 measurements were applied to the tibialis anterior compartment's ICP of 30 healthy volunteers. The experimental data were analyzed using the Bland-Altman method. Once it was considered to be a substitute for the Whitesides apparatus based on statistical analysis, we used IABPMS to measure the ICP of the patients suspected of having ACS to estimate its clinical prospect. RESULTS: The rabbit models' ICP estimated by the Whitesides apparatus and IABPMS were 9.60±2.74 and 9.55±2.33 mm Hg, with an increase to 30.20±4.44 and 30.05±4.58 mm Hg after modeling, respectively. The limits of agreement for the ICP were -2.01/2.11 and -2.41/2.71 mm Hg before and after model establishment. The healthy volunteers' ICP were 10.92±6.06 and 10.85±5.87 mm Hg; the limits of agreement for the ICP were -2.53/2.66 mm Hg. With IABPMS to continuously monitor the ICP increasing (40.45±10.42 vs 13.82±4.94 mm Hg) and ΔP (34.54±11.77 mm Hg) to guide the diagnosis of ACS, 5 of 11 patients underwent the emergency fasciotomy for decompression. CONCLUSION: The invasive pressure monitoring via IABPMS can be used as an alternative to the Whitesides method, thanks to the sufficient agreement between the 2 methods in ICP measurement, and also for its advantages recommended as a novel diagnostic approach to ACS in experimental and clinical applications.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Pressão Arterial , Monitores de Pressão Arterial , Adulto , Animais , Síndrome do Compartimento Anterior/cirurgia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Descompressão Cirúrgica , Fasciotomia , Feminino , Traumatismos do Antebraço/complicações , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Animais , Pressão , Coelhos , Coxa da Perna , Torniquetes , Adulto JovemRESUMO
OBJECTIVES: Compartment syndrome (CS) is a potentially devastating injury associated with tibial fractures. Few data exist regarding radiographic indicators of CS. We hypothesized that radiographic signs are associated with development of CS. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS: Consecutive series of adult patients with tibial fractures with (n = 56) and without (n = 922) CS. INTERVENTION: None. OUTCOMES: AO/OTA fracture classification, Schatzker type, fracture length, fibular fracture, CS diagnosis. RESULTS: The odds of CS increased by 1.67 per 10% increase in the ratio of fracture length to tibial length when considering all fractures. CS was most likely to occur with plateau fractures at 12% (shaft fractures, 3%; pilon fractures, 2%). Schatzker VI fractures were more likely to develop CS than any other Schatzker type. Fibular fracture was predictive of CS with plateau fractures only. Segmental fractures (AO/OTA type 42-C2) were not more likely to develop CS than other shaft fractures. CONCLUSIONS: Several objective and easily reproducible radiographic indicators should raise suspicion for CS. CS was more likely in plateau fractures, especially when fracture length was >20% of the tibial length, in the presence of fibular fracture, and classified as Schatzker VI. Conversely, segmental tibial shaft fractures were not more likely than other shaft fractures to develop CS. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Síndrome do Compartimento Anterior/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Radiografia , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/cirurgia , Adulto , Idoso , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/etiologia , Estudos de Coortes , Descompressão Cirúrgica/métodos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fraturas da Tíbia/complicações , Centros de Traumatologia , Resultado do TratamentoRESUMO
BACKGROUND: Near-infrared spectroscopy measures muscle oxygen saturation (StO2) in the skeletal muscle and has been proposed as a noninvasive tool for diagnosing chronic anterior compartment syndrome (CACS). The purpose of this study was to investigate the diagnostic value of changes in StO2 during and after exercise in patients with CACS. METHODS: The study comprised 159 consecutive patients with exercise-induced leg pain. Near-infrared spectroscopy was used to measure StO2 continuously before, during, and after an exercise test. One minute post-exercise, intramuscular pressure was recorded in the same muscle. The cohort was divided into patients with CACS (n = 87) and patients without CACS (n = 72) according to the CACS diagnostic criteria. Reoxygenation at rest after exercise was calculated as the time period required for the level of muscular StO2 to reach 50% (T50), 90% (T90), and 100% (T100) of the baseline value. RESULTS: The lowest level of StO2 during exercise was 1% (range, 1% to 36%) in the patients with CACS and 3% (range, 1% to 54%) in the patients without CACS. The sensitivity was 34% and the specificity was 43% when an StO2 level of ≤8% at peak exercise was used to indicate CACS. The sensitivity and the specificity were only 1% when an StO2 level of ≤50% at peak exercise was used to indicate CACS. The time period for reoxygenation was seven seconds (range, one to forty-three seconds) at T50, twenty-eight seconds (range, seven to seventy-seven seconds) at T90, and forty-two seconds (range, seven to 200 seconds) at T100 in the patients with CACS and ten seconds (range, one to forty-nine seconds) at T50, thirty-two seconds (range, four to 138 seconds) at T90, and forty-eight seconds (range, four to 180 seconds) at T100 in the patients without CACS. When thirty seconds or more at T90 was set as the cutoff value for a prolonged time for reoxygenation, indicating a diagnosis of CACS, the sensitivity was 38% and the specificity was 50%. CONCLUSIONS: Changes in muscle oxygen saturation during and after an exercise test that elicits leg pain cannot be used to distinguish between patients with CACS and patients with other causes of exercise-induced leg pain.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Teste de Esforço/métodos , Músculo Esquelético/metabolismo , Consumo de Oxigênio/fisiologia , Estudos de Casos e Controles , Doença Crônica , Eletromiografia/métodos , Tolerância ao Exercício/fisiologia , Feminino , Humanos , Perna (Membro) , Masculino , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Valores de Referência , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de TempoRESUMO
Chronic exertional compartment syndrome of the leg is a debilitating lower extremity condition in which increased intracompartmental pressure impedes blood flow to the involved compartments of the distal lower extremity, resulting in ischemia and pain. Owing to the lack of success with conservative management, most surgeons perform complete release fasciotomy as the preferred method of fasciotomy to avoid an unsuccessful release or outcome. Studies have been performed regarding the outcomes of complete compartmental release versus specific compartmental release, but no study has been performed comparing complete fasciotomy and compartment-specific fasciotomy in a single patient. The purpose of the present case report was to compare the efficacy of a complete fasciotomy versus a specific fasciotomy in 1 patient with properly diagnosed bilateral anterior compartment chronic exertional compartment syndrome with an 18-month follow-up period. The Lower Extremity Functional Scale and both subscales of the Foot and Ankle Ability Measure were administered to assess the functional outcomes. Circumferential measurements and range of motion photographs were taken to compare the objective data throughout the recovery process. In general, the range of motion, circumferential measurements, and functional outcome measure scores were better for the specific compartmental fasciotomy leg than for the complete fasciotomy leg during the recovery period. The overall functional outcomes were the same for both surgical approaches, with the specific fasciotomy leg returning to baseline function 13 to 23 days before the complete fasciotomy leg. The outcomes remained unchanged 18 months after surgery.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/cirurgia , Fasciotomia/métodos , Medição da Dor , Adulto , Doença Crônica , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/reabilitação , Fasciotomia/reabilitação , Seguimentos , Humanos , Masculino , Cuidados Pós-Operatórios , Recuperação de Função Fisiológica , Medição de Risco , Corrida/fisiologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: We test a novel simulated teaching module's ability to educate junior residents in the assessment of compartment syndrome (CS) and compartment pressure measurement (CPM). METHODS: Twenty-two postgraduate year 1 and postgraduate year 2 surgical residents received a 2-hour didactic and practical teaching module on CS assessment and CPM using a simulated model. A structured teaching session by a postgraduate year 5 surgical resident was assessed by carefully constructed pretest, post-test, and delayed retention tests and a practical testing session by 2 board-certified general surgeons. RESULTS: Analysis of variance demonstrated significant difference between pretest (6.1/10), post-test (7.9/10), and retention test (8.2/10) scores [F (2,49) = 9.24, P < .01], with no difference in post-test to retention test comparison (P = .90). Mean CPM scores were 8.5/10 for preparation, 9.0/10 for performance, and 8.5/10 for management components, which did not differ [F (2,57) = .46, P = .63]. CONCLUSIONS: We demonstrate an efficient simulated CS and CPM teaching module for the education of junior surgical residents using a synthetic model.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/cirurgia , Cirurgia Geral/educação , Internato e Residência , Modelos Anatômicos , Treinamento por Simulação , Competência Clínica , Currículo , HumanosRESUMO
RESU MEN: El SCIE representa la causa del 27% de los cuadros de dolor anterior de pierna en atletas. El origen del dolor en este cuadro es aún discutido. La medición de la presión intracompartimental es el gold standard en el diagnóstico, aunque es un estudio invasivo. El desarrollo e interpretación de nuevas secuencias en RMN, aportaron una alternativa en el diagnóstico incruento del SCIE. La RMN post-esfuerzo es una opción atractiva y atraviesa en la actualidad su proceso de validación. MATERIAL Y MÉT ODOS Se evaluaron 22 pacientes con diagnóstico clínico de síndrome compartimental inducido por el ejercicio, con una media de seguimiento de 5 años (1-10 años). Todos fueron evaluados mediante examen clínico, RM pre y post actividad física y medición de presión intracompartimental pre y post actividad física. La resonancia magnética se realizó en reposo y luego de la prueba de esfuerzo. La medición de presión intracompartimental se realizó con la técnica de Whitesides, el diagnóstico se realizó con los criterios de Pedowitz. RESULTADOS De los 22 pacientes, 19 tuvieron una medición intracompartimental positiva (15 masculino, 4 femenino) y 3 una medición negativa. Todos los pacientes tuvieron una RMN normal en reposo. En los 3 pacientes que tuvieron medición intracompartimental negativa, la RMN post-esfuerzo fue normal. De los 19 pacientes restantes, la RMN detectó señal hiperintensa en T2 y STIR en 15 de ellos (78,95%). CONCLUSIONES La RMN podría tener un lugar en el diagnóstico, para lo cual debería mejorarse la sensibilidad de este método. No obstante, la medición intracompartimental pre y post-esfuerzo sigue siendo el gold-standard. Nivel de evidencia: IV
BACKGROUND: Chronic exertional compartment syndrome (CECS) is the cause of 27% of anterior leg pain in athletes. The source of pain in this condition is still debated. Measurement of intracompartmental pressure is the gold standard diagnosis, albeit an invasive study. The development and interpretation of new MRI sequences has provided a non-invasive alternative to CECS diagnosis. Post-exercise MRI is an attractive option which is currently undergoing its validation process. METHODS: 22 patients with a clinical diagnosis of CECS were included, with a median follow-up of 5 years (1-10 years). All the patients were evaluated by clinical examination, pre- and post-exercise MRI and pre-and post-exercise intracompartmental pressure measurement. Pressure was measured with Whitesides technique, and diagnosis was carried out by Pedowitz criteria. RESULTS: Out of the total 22 patients, 19 had positive intracompartmental measurement (15 male, 4 female) and 3 had negative measurement. All the patients had a normal MRI at rest. The three patients who had negative intracompartmental measurement had a normal post-stress MRI. Out of the remaining 19 patients, the MRI detected hyperintense signal in T2 and STIR weighted in 15 of them (78,95%). CONCLUSIONS: MRI could be relevant for diagnosis, for which case the sensitivity of this method should be improved. Nevertheless, pre- and post-stress intracompartmental measurement continues to be the gold-standard. Level of evidence: IV
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Exercício Físico , Imageamento por Ressonância Magnética/métodos , Perna (Membro) , Síndrome do Compartimento Anterior/diagnóstico , Traumatismos em AtletasAssuntos
Síndrome do Compartimento Anterior/diagnóstico , Exercício Físico/fisiologia , Perna (Membro)/fisiopatologia , Dor/diagnóstico , Atenção Primária à Saúde , Adulto , Síndrome do Compartimento Anterior/fisiopatologia , Síndrome do Compartimento Anterior/cirurgia , Doença Crônica , Fasciotomia , Humanos , Masculino , Dor/etiologia , Medição da Dor , Guias de Prática Clínica como Assunto , Encaminhamento e ConsultaRESUMO
Introducción: El síndrome compartimental es una situación en lacual el incremento de la presión dentro de un espacio cerrado,porencima de la presión de perfusión, afecta la circulación de lostejidos que están dentro de dicho espacio, comprometiendo lavitalidad de los mismos y ocasionando lesión tisular. En miembrosuperior se describen numerosos compartimientos en los queIntroducción: El síndrome compartimental es una situación en lacual el incremento de la presión dentro de un espacio cerrado,porencima de la presión de perfusión, afecta la circulación de lostejidos que están dentro de dicho espacio, comprometiendo lavitalidad de los mismos y ocasionando lesión tisular. En miembrosuperior se describen numerosos compartimientos en los quepodría ocurrir dicho fenómeno ,y es particularmente el antebrazouna de las regiones anatómicas donde suele suceder con mayorfrecuencia. Objetivo: Evaluar el conocimiento anatómico de los compartimientos en el antebrazo con posibilidad de sufrir unsíndrome compartimental para la realización de abordajesquirúrgicos de urgencia. Material y Método: Se realizaron encuestas anónimasevaluando el conocimiento anatómico sobre el tema a 11médicos cirujanos en formación y a 25 ayudantes de anatomía...
Introduction: Compartment syndrome is a situation in which increassed pressure within a closed space above perfusión pressure affects the tissues circulation into that space,compromising the vitality of them and causing tissue injury.In upper limb there are many compartments where this fenomenous may occur, and the forearm is one of the anatomicregions where normally occure more frequently. Objectives: To evaluate the anatomic knowledge of the forearm compartements with possibility of having a compartmentsyndrome for the realization of urgent surgical approaches. Material and Methods: Anonymous surveys were conducted toevaluate the anatomical knowledge of the subject to 11 trainingsurgeons and 25 anatomy assistants...
Assuntos
Humanos , Antebraço/anatomia & histologia , Antebraço/patologia , Cirurgia Geral , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/terapiaRESUMO
We report a case of bilateral anterolateral crural compartment syndrome elicited by hyponatraemia and psychogenic polydipsia. The unusual constellation of clinical findings and diminished pain expression made initial diagnostic procedures challenging. The possible pathogenesis and treatment options are discussed. Impairment of lower extremity function at follow-up was serious and permanent.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Antibacterianos/uso terapêutico , Polidipsia Psicogênica/diagnóstico , Intoxicação por Água/diagnóstico , Adulto , Síndrome do Compartimento Anterior/etiologia , Síndrome do Compartimento Anterior/terapia , Órtoses do Pé , Humanos , Masculino , Polidipsia Psicogênica/complicações , Polidipsia Psicogênica/terapia , Rabdomiólise/complicações , Esquizofrenia Paranoide , Resultado do Tratamento , Intoxicação por Água/complicações , Intoxicação por Água/terapiaRESUMO
BACKGROUND: We sought to examine the occurrence of acute compartment syndrome (ACS) in the cohort of patients with tibial diaphyseal fractures and to detect associated risk factors that could predict this occurrence. MATERIALS AND METHODS: A total of 1,125 patients with tibial diaphyseal fractures that were treated in our centre were included into this retrospective cohort study. All patients were treated with surgical fixation. Among them some were complicated by ACS of the leg. Age, gender, year and mechanism of injury, injury severity score (ISS), fracture characteristics and classifications and the type of fixation, as well as ACS characteristics in affected patients were studied. RESULTS: Of the cohort of patients 772 (69 %) were male (mean age 39.60 ± 15.97 years) and the rest were women (mean age 45.08 ± 19.04 years). ACS of the leg occurred in 87 (7.73 %) of all tibial diaphyseal fractures. The mean age of those patients that developed ACS (33.08 ± 12.8) was significantly lower than those who did not develop it (42.01 ± 17.3, P < 0.001). No significant difference in incidence of ACS was found in open versus closed fractures, between anatomic sites and following IM nailing (P = 0.67). Increasing pain was the most common symptom in 71 % of cases with ACS. CONCLUSIONS: We found that younger patients are definitely at a significantly higher risk of ACS following acute tibial diaphyseal fractures. Male gender, open fracture and IM nailing were not risk factors for ACS of the leg associated with tibial diaphyseal fractures in adults. LEVEL OF EVIDENCE: Level IV.
Assuntos
Síndrome do Compartimento Anterior/epidemiologia , Fraturas da Tíbia/complicações , Adulto , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/terapia , Diáfises , Feminino , Fixação Interna de Fraturas , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fraturas da Tíbia/diagnóstico , Fraturas da Tíbia/cirurgia , Adulto JovemRESUMO
BACKGROUND: Patients with chronic exertional compartment syndrome (CECS) have pain during exercise that subsides with rest. Diagnosis is usually confirmed by intramuscular compartment pressure (IMCP) measurement. Controversy exists regarding the accuracy of existing diagnostic criteria. PURPOSE: (1) To compare dynamic IMCP measurement and anthropometric factors between patients with CECS and asymptomatic controls and (2) to establish the diagnostic utility of dynamic IMCP measurement. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A total of 40 men aged 21 to 40 years were included in the study: 20 with symptoms of CECS of the anterior compartment and 20 asymptomatic controls. Diagnoses other than CECS were excluded with rigorous inclusion criteria and magnetic resonance imaging. The IMCP was measured continuously before, during, and after participants exercised on a treadmill, wearing identical footwear and carrying a 15-kg load. RESULTS: Pain experienced by study subjects increased incrementally as the study progressed (P < .001). Pain levels experienced by the case group during each phase of the exercise were significantly different (P = .021). Subjects had higher IMCP immediately upon standing at rest compared with controls (23.8 mm Hg [controls] vs 35.5 mm Hg [subjects]; P = .006). This relationship persisted throughout the exercise protocol, with the greatest difference corresponding to the period of maximal tolerable pain (68.7 mm Hg [controls] vs 114 mm Hg [subjects]; P < .001). Sensitivity and specificity were consistently higher than the existing criteria with improved diagnostic value (sensitivity = 63%, specificity = 95%; likelihood ratio = 12.5 [95% CI, 3.2-49]). CONCLUSION: Anterior compartment IMCP is elevated immediately upon standing at rest in subjects with CECS. In patients with symptoms consistent with CECS, diagnostic utility of IMCP measurement is improved when measured continuously during exercise. A cutoff of 105 mm Hg in phase 2 provides better diagnostic accuracy than do the Pedowitz criteria of 30 mm Hg and 20 mm Hg at 1 and 5 minutes after exercise, respectively.
Assuntos
Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/fisiopatologia , Exercício Físico/fisiologia , Esforço Físico/fisiologia , Adulto , Síndrome do Compartimento Anterior/complicações , Área Sob a Curva , Estudos de Casos e Controles , Teste de Esforço , Humanos , Imageamento por Ressonância Magnética , Masculino , Dor/etiologia , Pressão , Estudos Prospectivos , Curva ROC , Descanso/fisiologia , Adulto JovemAssuntos
Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/cirurgia , Descompressão Cirúrgica/métodos , Hipotireoidismo/diagnóstico , Síndrome do Compartimento Anterior/complicações , Desbridamento/métodos , Seguimentos , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Medição de Risco , Índice de Gravidade de Doença , Tiroxina/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
Introducción: el síndrome compartimental en cirugía cardiovascular tiene diferentes causas, entre ellas las que se derivan del fenómeno isquemia reperfusión luego de un tiempo de circulación extracorpórea y pinzamiento aórtico prolongado, sobretodo si se canulan los vasos femorales. Objetivo: presentar un caso clínico de Síndrome Compartimental poscirculación extracorpórea. Desarrollo: se trata de un paciente masculino de 28 años, con antecedentes de intervenciones cardiacas previas, al que se le realizó nuevamente sustitución protésica aórtica, por incompetencia de la prótesis valvular. Durante la intervención se canuló por la arteria y vena femoral derechas para realización de la circulación extracorpórea, con tiempo prolongado de paro y de circulación extracorpórea. Se tomaron medidas de protección cerebral con hiportermia profunda y se trasladó para la terapia, ventilado, bajo los efectos anestésicos. Luego de la recuperación y extubación, refirió dolor intenso en el miembro inferior derecho, con aumento progresivo del volumen del mismo, sobretodo en la región posterior de la pierna, que se hizo tensa, con disminución de los pulsos pedios y gradiente térmico. Paralelamente se encontró aumento del potasio sérico, que se trató enérgicamente, así como cifras de CPK muy elevadas, mioglobinuria y oligoanuria, tratándose según protocolo de protección renal. Por el cuadro presentado se diagnosticó un síndrome compartimental y se solicitó valoración por el Servicio de Angiología. Se confirmó el diagnóstico y se realizó fasciotomía descompresiva. Tuvo una evolución favorable, lográndose salvar el miembro afectado. Conclusiones: el diagnóstico y la actuación precoz permiten limitar y disminuir las complicaciones del síndrome compartimental(AU)
Introduction: compartment syndrome associated to cardiovascular surgery may result from various factors, among them the ischemia-reperfusion phenomenon following a period of extracorporeal circulation and prolonged aortic clamping, especially when the femoral vessels are cannulated. Objective: present a clinical case of compartment syndrome after extracorporeal circulation. Method: a male 28-year-old patient with a history of cardiac surgery underwent prosthetic aortic replacement once again due to prosthetic valve incompetence. Cannulation was performed during surgery via the right femoral artery and vein to set up extracorporeal circulation, with prolonged cardiac arrest and extracorporeal circulation time. Cerebral protection measures were taken with the use of deep hypothermia, and the patient was transferred to the therapy ward ventilated and under the effect of anesthetics. After recovery and extubation, the patient referred intense pain on his right lower limb, whose volume had gradually increased, especially the posterior region of the leg, which turned tense, with reduced pedal pulses and thermal gradient. An increase in serum potassium was also observed, which was treated energetically, as well as very high CPK values, myoglobinuria and oligonuria, all of which were approached in compliance with the renal protection protocol. The patient's condition was diagnosed as compartment syndrome, and an assessment was requested from the Angiology Service. The diagnosis was confirmed and decompressive fasciotomy was performed. The patient evolved favorably and the affected limb was preserved. Conclusions: early diagnosis and management make it possible to limit and reduce the complications of compartment syndrome(AU)
Assuntos
Humanos , Masculino , Adulto , Síndrome do Compartimento Anterior/diagnóstico , Síndrome do Compartimento Anterior/complicações , Circulação Extracorpórea/métodosRESUMO
The idiomuscular response to direct percussion is rarely tested nowadays because of its uncertain mechanism and significance. While performing neurological examination, we observed a brisk ankle dorsiflexion response on direct muscle percussion of m. tibialis anterior in patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP). In contrast, in patients with upper motor neuron lesions, an ankle inversion response was seen. In this article we describe our findings in patients with bilateral lower limb weakness. We assessed 73 consecutive patients with bilateral lower limb weakness. A strong dorsiflexion response to percussion of m. tibialis anterior was seen in 11 out of 14 patients with AIDP (sensitivity 78.6%). None of the other patients showed a strong dorsiflexion response (specificity 100%). An inversion response was seen in 11 out of 13 patients with UMN involvement (sensitivity 92.3%). It was also noted in two of 46 patients without proven UMN involvement (specificity 96.7%). The idiomuscular response to percussion of m. tibialis anterior can be useful in the assessment of patients with lower limb weakness of unclear cause.