Compartment syndrome and Volkmann's ischemic contracture:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Hand clinics
14,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XV S., S. 331 - 510 zahlr. Ill., graph. Darst. |
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| adam_text | COMPARTMENT SYNDROME AND VOLKMANN S ISCHEMIC CONTRACTURE
CONTENTS
Preface xiii
Michael J. Botte
Definitions and Terminology of Compartment Syndrome and
Volkmann s Ischemic Contracture of the Upper Extremity 331
Herbert P. von Schroeder and Michael J. Botte
Increased tissue pressure within a nondistensible compartment decreases
blood flow and oxygenation to the compartment and can result in cellular
damage. This condition is defined as compartment syndrome and can lead
to Volkmann s ischemic contracture. Volkmann s contracture can be mild,
moderate, or severe. The outcome is typically irreversible but can be
prevented by early diagnosis of an impending compartment syndrome.
A Historical Review of Compartment Syndrome and Volkmann s
Ischemic Contracture 335
Michael Trice and Clifford W. Colwell
Compartment syndrome has been a recognized disease entity since the
mid nineteenth century. This article reviews the extensive research, clinical
observations, and contributions by clinicians over the past century that
have the provided the basis for our current perspective on pathogenesis,
diagnosis, and treatment of this disease entity.
Anatomy of the Upper Extremity Muscle Compartments 343
James R. Doyle
Multiple anatomic compartments are present in the upper extremity. These
compartments are defined as anatomic spaces formed by fascia, or a
combination of fascia and bone, that contain one or more muscles. In
addition to muscle tissue, these compartments also contain arteries, veins,
and nerves. The muscle component of the various compartments is the
primary target of the pathologic process of compartment syndrome,
whereas the nerves are the secondary targets. Following sustained vascular
compromise, the muscle undergoes necrosis, fibrosis, and contracture. As¬
sociated nerve compromise may cause further muscle dysfunction both
locally and distally. Knowledge of these anatomic compartments and their
HAND CLINICS
VOLUME 14 • NUMBER 3 • AUGUST 1998 vii
contents aids in early diagnosis and effective treatment of compartment
syndrome.
Causes of Upper Extremity Compartment Syndrome 365
Satoshi Yamaguchi and Steven F. Viegas
Multiple causes, including various types of trauma, prolonged compres¬
sion, muscle avulsions, burn, snake bites, high pressure injection injuries,
exercise, infection, bleeding, and intravenous drug infiltration, have been
reported to lead to the development of a compartment syndrome in the
upper extremity. Awareness of the different causes and risks of compart¬
ment syndrome should facilitate early diagnosis and prompt treatment to
help avoid the development of serious sequelae such as Volkmann s ische
mic contracture. A review of the various reports of upper extremity com¬
partment syndromes and classification systems is presented to assist in
the understanding of this condition s development.
Current Concepts in the Pathophysiology, Evaluation, and Diagnosis
of Compartment Syndrome 371
Alan R. Hargens and Scott J. Mubarak
This article reviews present knowledge of the pathophysiology, evaluation,
and diagnosis of acute compartment syndromes. A compartment syn¬
drome exists when edema or blood accumulates within a confined osseofa
cial space such that intramuscular pressure is elevated at a sufficient
magnitude and time to reduce capillary perfusion and to risk tissue viabil¬
ity. Compartment syndromes are usually characterized by the six so
called Ps: high pressure, pain (especially with passive stretch), paresthesia,
paresis, pink skin color, and pulse (distal pulse present). Intramuscular
pressure thresholds for decompression fasciotomy range between 30 to 50
mm Hg, depending on clinical signs and systemic blood pressure. How¬
ever, time factors are also important and usually are incompletely known
in most cases of acute compartment syndrome. Recent development of
miniature transducer tipped catheters and the future development of non
invasive techniques may provide accurate recordings of intramuscular
pressure in patients with acute compartment syndromes.
Acute Compartment Syndrome of the Arm 385
Harris Gellman and Keyur Buch
Compartment syndrome of the arm, although uncommon, may result in
significant disability if the diagnosis is missed. A high index of suspicion
is needed, particularly in those patients at high risk, especially intoxicated
or comatose patients. This article discusses the relevant anatomy, patho
genesis, diagnosis, prognosis, and complications of this syndrome.
Acute Compartment Syndrome of the Forearm 391
Michael J. Botte and Richard H. Gelberman
The forearm is the most common site for compartment syndrome in the
upper extremity. The three compartments of the forearm are the volar
(anterior or flexor), dorsal (posterior or extensor), and mobile wad. Clinical
findings include a swollen, tense compartment, severe pain, and sensory
and motor deficits. Initial treatment consists of removing occlusive dress¬
ings, splitting, or casts. If symptoms do not resolve rapidly, fasciotomy is
indicated. Decompression fasciotomy of the forearm is performed through
volar or dorsal approaches. The medial nerve is decompressed throughout
its course, including high risk areas deep to the lacertus fibrosus, between
the humeral and ulnar heads of the pronator teres, the proximal arch
Viii CONTENTS
and deep fascial surface of the flexor digitorum superficialis, and the
carpal tunnel
Compartment Syndrome of the Hand and Wrist 405
Jose A. Ortiz, Jr, and Richard A. Berger
This article discusses the anatomy, causes, diagnosis, treatment, and com¬
plications of compartment syndrome of the hand and wrist. Special consid¬
eration is given to different methods of pressure measurements, including
Whitesides method, Matsen s method, and the wick catheter method.
Acute Carpal Tunnel Syndrome 419
Robert M. Szabo
Although the carpal tunnel is open at both ends, it has the physiologic
properties of a closed compartment bounded by synovium proximally and
distally. When the intracarpal canal interstitial pressure rises above a
critical threshold pressure, capillary blood flow is reduced below the level
required for median nerve viability. Acute carpal tunnel syndrome is
recognized frequently as occurring secondary to wrist trauma and infre¬
quently due to a variety of infectious, rheumatologic, and hematologic
disorders. This condition warrants prompt recognition and the treatment
is early carpal tunnel release.
Compartment Syndromes in Obtunded Patients 431
Elizabeth Anne Ouellette
A high index for compartment syndrome should be maintained in all
patients with an injured upper extremity. This is particularly important in
obtunded patients and any other patients whose ability to communicate
is impeded. Such patients include victims of severe or multiple trauma,
particularly to the head, spinal cord, or upper extremity nerves; burn
victims; patients who are under anesthesia or sedated; critically ill patients;
substance abusers or drug overdosed patients; mentally ill or disabled
patients; and infants and young children. Common causes of upper ex¬
tremity compartment syndromes in these patients are prolonged limb
compression due to drug overdose, extravasation of intravenous or arterial
fluid administration, thrombolytic therapy for myocardial infarction, and
trauma. If a compartment syndrome of the forearm, hand, or upper arm
is suspected, the patient should be examined closely and frequently, and
changes over time should be documented carefully. Adjunctive diagnostic
techniques, particularly intracompartmental pressure measurement, play
an essential role in these patients, in whom it may be difficult or impossi¬
ble to assess symptoms and signs or make an accurate differential diagno¬
sis by physical examination alone. Once a compartment syndrome is
diagnosed, emergent fasciotomy is needed to prevent devastating loss
of function.
Crush Syndrome of the Upper Extremity 451
Herbert P. von Schroeder and Michael J. Botte
Crush syndrome is the systemic manifestation of prolonged muscle com¬
pression and compartment syndrome. Early diagnosis and aggressive
treatment are necessary to prevent multiple organ failure and death. Prog¬
nosis is improved by early diagnosis and treatment, however, outcome
of the injured extremity is typically poor and Volkmann s contracture
often results.
CONTENTS ix
The Role of Prophylactic Fasciotomy and Medical Treatment in Limb
Ischemia and Revascularization 457
Eric P. Hofmeister and Alexander Y. Shin
Multiple studies have demonstrated that muscle poorly tolerates ischemia.
When the ischemic state is unduly prolonged, the successfully replanted
or revascularized limb undergoes deleterious biochemical reactions that
cascade to vessel intimal damage, increased vessel permeability, and low¬
ering of pH. The resultant tissue edema leads to increasing compartment
pressures, which not only impede the recovery of function, but also can
lead to irreversible muscle necrosis, increased risk of infection, and sepsis
if not reversed in a timely fashion. The development of compartment
syndrome jeopardizes not only the injured limb, but life itself secondary
to the biochemical toxins produced by the ischemic extremity. A thorough
understanding of the biochemistry of ischemia and reperfusion provides
insight into the role of fasciotomy in the replanted or revascularized
extremity. The scientific basis for fasciotomy in the revascularized or re¬
planted limb is discussed as well as the potential protective role of
pharmacologic agents in ischemic and reperfusion injury.
Upper Extremity Pediatric Compartment Syndromes 467
R. Kumar Kadiyala and Peter M. Waters
Compartment syndrome is a rare but potentially devastating problem in
children with upper extremity injuries. Awareness, early detection, and
recognition of injury patterns that are associated with compartment syn¬
drome are important to prevent the disastrous outcomes of ischemic con
tracture. The authors have found profound anxiety in the face of an
increasing analgesic requirement to be the most reliable indicator of com¬
partment syndrome in a child.
Exertional Compartment Syndrome of the Upper Extremity 477
Michael J. Botte, Jan Fronek, Robert A. Pedowitz, Heinz R. Hoenecke, Jr,
Reid A. Abrams, and Merlin L. Hamer
Exertional compartment syndrome is characterized by intracompartmental
pressures that rise transiently following repetitive motion or exercise,
thereby producing temporary, reversible ischemia, pain, weakness, and,
occasionally, neurologic deficits. The exact cause or pathogenesis remains
unclear; a disturbance of microvascular flow caused by elevated intramus¬
cular pressure leads to tissue ischemia, depletion of high energy phosphate
stores, and cellular acidosis. Anatomic contributing factors may include a
limited compartment size, increased intracompartmental volume, con¬
stricted fascia, loss of compartment elasticity, poor venous return, or in¬
creased muscle bulk. The diagnosis is suspected based on history and
confirmed with physical examination and intramuscular pressure evalua¬
tion before and after exercise (stress test). Differential diagnosis includes
claudication or other vascular abnormalities, myositis, tendinitis, periosti¬
tis, chronic strains or sprains, stress fracture, other compression or systemic
neuropathies, and cardiac abnormalities with angina or referred extremity
pain. Initial treatment includes activity modification; refractory symptoms
can be managed with elective fasciotomy.
Volkmann s Ischemic Contracture of the Upper Extremity 483
Michael J. Botte, Mary Ann E. Keenan, and Richard H. Gelberman
Upper extremity deformity of ischemic contracture usually includes elbow
flexion, forearm pronation, wrist flexion, thumb flexion and adduction,
digital metacarpophalangeal joint extension, and interphalangeal joint
flexion. Treatment of mild contractures consists of either nonoperative
management with a comprehensive rehabilitation program (to increase
x CONTENTS
range of motion and strength) or operative management consisting of
infarct excision or tendon lengthening. Treatment of moderate to severe
contractures consists of release of secondary nerve compression, treatment
of contractures (with tendon lengthening or recession), tendon or free
tissue transfers to restore lost function, and/or salvage procedures for the
severely contracted or neglected extremity.
Reconstruction of Intrinsic Hand Deformities 499
Frank S. Lee and Harris Gellman
Intrinsic muscle contractures are a frequently overlooked cause of hand
dysfunction. Tightness of these muscles may occur despite appropriate
management. This article addresses the evaluation and treatment of these
contractures.
Index 507
Subscription Information Inside back cover
CONTEXTS xi
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| spelling | Compartment syndrome and Volkmann's ischemic contracture Michael J. Botte, guest ed. Philadelphia [u.a.] Saunders 1998 XV S., S. 331 - 510 zahlr. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Hand clinics 14,3 Armen (ledematen) gtt Compartiment-syndroom gtt Contracturen gtt Loge musculaire, syndrôme Compartment Syndromes Compartment syndrome Kompartmentsyndrom (DE-588)4212791-9 gnd rswk-swf Volkmann-Kontraktur (DE-588)4526694-3 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Kompartmentsyndrom (DE-588)4212791-9 s DE-604 Volkmann-Kontraktur (DE-588)4526694-3 s Botte, Michael J. Sonstige oth Hand clinics 14,3 (DE-604)BV000019309 14,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008263012&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Compartment syndrome and Volkmann's ischemic contracture Hand clinics Armen (ledematen) gtt Compartiment-syndroom gtt Contracturen gtt Loge musculaire, syndrôme Compartment Syndromes Compartment syndrome Kompartmentsyndrom (DE-588)4212791-9 gnd Volkmann-Kontraktur (DE-588)4526694-3 gnd |
| subject_GND | (DE-588)4212791-9 (DE-588)4526694-3 (DE-588)4143413-4 |
| title | Compartment syndrome and Volkmann's ischemic contracture |
| title_auth | Compartment syndrome and Volkmann's ischemic contracture |
| title_exact_search | Compartment syndrome and Volkmann's ischemic contracture |
| title_full | Compartment syndrome and Volkmann's ischemic contracture Michael J. Botte, guest ed. |
| title_fullStr | Compartment syndrome and Volkmann's ischemic contracture Michael J. Botte, guest ed. |
| title_full_unstemmed | Compartment syndrome and Volkmann's ischemic contracture Michael J. Botte, guest ed. |
| title_short | Compartment syndrome and Volkmann's ischemic contracture |
| title_sort | compartment syndrome and volkmann s ischemic contracture |
| topic | Armen (ledematen) gtt Compartiment-syndroom gtt Contracturen gtt Loge musculaire, syndrôme Compartment Syndromes Compartment syndrome Kompartmentsyndrom (DE-588)4212791-9 gnd Volkmann-Kontraktur (DE-588)4526694-3 gnd |
| topic_facet | Armen (ledematen) Compartiment-syndroom Contracturen Loge musculaire, syndrôme Compartment Syndromes Compartment syndrome Kompartmentsyndrom Volkmann-Kontraktur Aufsatzsammlung |
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