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Hand and Upper Limb Emergencies
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Compartment syndrome is a limb-threatening condition in which increased pressure within a closed (fascial) compartment compromises blood flow to muscles and nerves. If untreated it leads rapidly to tissue ischaemia and necrosis, which can ultimately result in loss of function, loss of limb, rhabdomyolysis and renal compromise. In the upper limb, compartment syndrome most commonly affects the deep compartment of the forearm but it can also affect other compartments of the forearm, hand and (less commonly) the upper arm. Acute compartment syndrome is a surgical emergency for which the only definitive management is decompression with fasciotomies. Time to theatres is crucial as irreversible tissue injury starts at approximately 3 hours of warm ischemia with 6 hours as the upper limit of muscle viability.
Musculoskeletal Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The treatment of compartment syndrome is surgical decompression. All four compartments below the knee should be widely opened. Thigh compartment syndrome is rare and requires decompression of the anterior and posterior compartments via a lateral approach. Flexor compartment syndrome in the forearm can be decompressed using a Henry anterior approach and carpal tunnel decompression.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Important symptoms of compartment syndrome would include pain, which is an early sign and often disproportionate to the injury sustained. It can be elicited with passive stretching of the muscle in the compartment that is affected. Patients may also complain of a tightness or pressure in the affected limb, which is another early indication of developing pathology. Paraesthesia is another early sign and may be in the distribution of the nerve if it travels through the affected compartment. Objective signs, which are often late, include pallor suggesting vascular insufficiency, and pulselessness, although this would need to be confirmed on doppler ultrasound. Paralysis is one of the latest signs, suggesting loss of motor function in the limb. It can be difficult to interpret as the mechanism of injury may prevent movement, however in disease pathology, prolonged nerve or muscle injury can result in permanent damage.
Comparison and convergence of compartment syndrome techniques: a narrative review
Published in Expert Review of Medical Devices, 2023
Naveen Sharma, Nitin Mohan Sharma, Apurva Sharma, Sarfaraj Mirza
Figure 1 [3] describes the structure of a calf, showing the compartments. Compartment syndrome is a disorder characterized by increased pressure on the tissues or muscles, which is caused by an injury that causes swelling or bleeding within the compartment. Because fascia tissue does not stretch or expand easily, it helps maintain the position of the muscles. Consequently, any swelling, bleeding, or fluid release inside the compartment will exert additional pressure on the muscles, nerves, and so forth, which reduces the oxygenated blood flow and nutrients inside the compartment, resulting in internal damage. This condition may cause irreversible tissue damage if left untreated. Figure 2 [3] represents the condition of compartment syndrome, in which the blood flow has been reduced due to the increased pressure inside the compartments.
Brachial artery trauma as a complication of bicep muscle injury
Published in Baylor University Medical Center Proceedings, 2023
Charles Graham, Sarah Bergkvist, Peter Kimball, Katelyn Taylor, Mudassir Syed, Michael M. Mohseni
A 48-year-old man presented to the emergency department with complaints of swelling, pain, and limited range of motion of the right upper extremity (RUE). His symptoms began after feeling a pop in his right arm while losing an arm-wrestling contest 48 hours earlier. He was evaluated 12 hours after the initial injury and diagnosed with a possible bicep tendon rupture. At that time, the patient was discharged with a sling, pain medications, and orthopedic follow-up. He experienced worsening RUE swelling, numbness, paresthesias, and uncontrolled pain, prompting a return visit to the emergency department. The patient endorsed a history of untreated hypertension and testosterone use but denied any surgeries. His exam was significant for swelling and tenderness extending from the right anterior chest near the pectoralis major muscle distally to the antecubital fossa and forearm. Diffuse ecchymoses was present in the medial upper arm. He reported significant pain with active or passive range of motion testing of the RUE, thus limiting strength examination. The right radial pulse was difficult to palpate given the degree of swelling, but bedside Doppler ultrasound confirmed the presence of good pulse waveform. Laboratory evaluation was notable for a creatinine of 1.36 mg/dL and a creatine kinase of 520 U/L. Orthopedic surgery was consulted given concerns for development of compartment syndrome.
The synthetic cathinone α-pyrrolidinovalerophenone (α-PVP): pharmacokinetic and pharmacodynamic clinical and forensic aspects
Published in Drug Metabolism Reviews, 2018
Leandro Nóbrega, Ricardo Jorge Dinis-Oliveira
Levine et al. (2013) reported three cases of compartment syndrome associated with the intake of SC, two of which were cases after α-PVP use. The first case was an 18-year-old man with history of substance abuse and depression, who presented to the emergency room with agitation, tachycardia and hyperthermia that developed compartment syndrome in both forearms after injection in the left arm. The injection might have contributed to the development of the compartment syndrome in the left side (Levine et al. 2013). The second case was a 43-year-old male with history of polysubstance abuse who presented to the emergency room with altered mental status, agitation, diffuse pain, tachycardia, and tachypnea after snorting α-PVP. On the second day of hospitalization, the patient complained of increased back pain evolving the paraspinal muscles in the thoracolumbar region. A magnetic resonance showed bilateral paraspinal muscular edema in the lower thoracic spine and the entire lumbar spine and, thus, a paraspinal compartment syndrome was diagnosed. The third case was also a paraspinal compartment syndrome associated with MDPV use in which the patient remained on hemodialysis for 5 months (Levine et al. 2013). In all cases, the compartment syndrome manifestations were not present at presentation, a delay typical of drug- or exercise-induced compartment syndrome. According to the authors, the compartment syndromes were probably due to a hyperexcited and hyperadrenergic state that resulted in muscle overuse (Levine et al. 2013). There are no available studies in the literature that link α-PVP to direct myotoxic proprieties.